Doctors win battle of the brain bulge

MUMBAI: By patching up a burst blood vessel in a 68-year-old patient's brain with novel metallic device on Tuesday, New-York-based Dr Arani Bose and interventional neuro-radiologists of the KEM Hospital led by Dr Uday Limaye have notched up another landmark in the treatment of bleeding cerebral aneurysms (or bulges in vessels) without open surgery. In September 2000, the same team achieved a global first when they successfully repaired burst blood vessels both sides of a 65-year-old woman's brain.This was done by filling the ruptured aneurysms with a stent made from a self-expanding nickeltitanium combo, also called nitinol or smart memory alloy. The ultra-thin, fish-net like stent was invented at Smart Therapeutics, a company Dr Bose founded in 1998 treat aneurysms which had wide openings and were difficult to repair by surgery by packing them with springy platinum coils. Dr Bose's company was acquired by Boston Scientific last November. Brain aneurysms are weak, bulging areas that protrude from a brain artery like a thin spot on the inner tube of a tyre. They are increasingly common in older patients that include celebrities like Sharon Stone. When an aneurysm ruptures, blood flows into the brain, resulting in subarachnoid haemorrhage, the deadliest form of stroke that affects some 30,000 people annually in the U.S. alone. Ten to 15 per cent of these patients die before reaching the hospital, with more than 50 per cent fatalities occurring in the first 30 days after rupture. Of those who survive, approximately half suffer some permanent neurological deficit. The introduction of coiling in the early 1990s revolutionised the treatment of aneurysms. Earlier, patients were treated with brain surgery, to remove a piece of the skull and to clip the neck of the aneurysm. This involved searching through precious brain tissue to locate the aneurysm, and pinching the brain vessel with a tiny metal clip resembling a tie-clip or a clothespin, to cut off its blood supply and prevent further bleeding into the brain. The invention of the detachable platinum coil by Dr Guido Guglielmi at UCLA provided the first viable alternative to clipping. This minimally invasive method is among the latest advancements in treating brain aneurisms from within the artery. Because this surgery involves a smaller incision compared with that used in the conventional brain operation, it causes far less disruption of the patient's vital processes,'' says Dr Limaye. Consequently, the recovery is much faster, making it an attractive proposition.'' However, he also cautions that not all patients are candidates for the procedure. Much depends on the size, location and status of the aneurysm and the overall health of the patient. Coiling involves the insertion of a microcatheter into the patient's femoral artery in the groin, and with the help of computer-aided X ray scanners, guiding it up through the arterial pathways right to the brain artery with the aneurysm. The doctor then carefully inserts a platinum coil, twice the thickness of human hair, through the catheter inside the aneurysm. Additional smaller coils are fed in until the bulge is packed, like a Brillo pad, preventing further bleeding. Experts say, along with faster recovery, the added advantage of this technique for a developing country like India with overburdened health infra-structure is that there are far less chances of developing dangerous infections or seizures. Indeed, endovascular coiling has already become the treatment of choice in Western countries where patients can be treated either by surgery, or by key-hole incisions,'' Dr Bose told TNN. This became dramatically evident when an international trial, reported in the Lancet, was recently stopped on ethical grounds when it became clear that a year after treatment 31 per cent of the surgical patients were disabled or dead compared with 24 per cent of the 'coiled' patients.''