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New Treatment Option for Giant Cerebral Aneurysms

Oct 23, 2014 01:51PM ● By MED Magazine
By Alex Strauss  


Patients in the region suffering from giant brain aneurysms, many of whom may once have been considered untreatable, now have a viable and minimally invasive treatment option in Sioux Falls. The treatment, known as the Pipeline procedure, is being offered at Sanford by the region’s only interventional neurologist, Jitendra Sharma, MD, of Sanford Neurology.

Already known for his method of coiling aneurysms to reduce the likelihood of rupture, Dr. Sharma performed the area’s first procedures using the Pipeline Embolization Device this summer, under the guidance of a proctor.

Pipeline has been approved by the FDA as an alternative to clipping a cerebral aneurysm during an open surgical procedure or coiling. Only about 15-20% of cerebral aneurysms are amenable to one of these two treatment options and Dr. Sharma says that neither is a particularly good option for people with the largest brain aneurysms.  “What we often see in patients with giant aneurysms that we treat with coiling, is that we may have to go back in later and put in more coils,” says Dr. Sharma.

During a Pipeline flow diversion procedure, a microcatheter is threaded past the aneurysm and the device is deployed across the neck of the aneurysm in the parent blood vessel.  “The Pipeline device is essentially a stent,” explains Dr. Sharma. “You don’t even have to go inside the aneurysm. It allows you to deploy in the blood vessel and actually divert blood away from the aneurysm.”

Once the device is in place, the body itself takes over the healing process. “In six months, the vessel begins to shrink and in another six months, the vessel is remodeled,” says Dr. Sharma. To assist in the remodeling process, patients are typically on Plavix or aspirin for a period of time.

The Pipeline device is especially helpful in patients with the largest brain aneurysms (over 10 mm) since these aneurysms tend to put pressure on different parts of the brain and cause unpleasant symptoms. Placing a coil in such an aneurysm could actually increase that pressure and those symptoms. But Sharma says shrinking the aneurysm with the Pipeline flow diversion procedure reduces that pressure and helps resolve symptoms.

Pipeline requires a high level of expertise and is currently only being offered in larger centers and those with unique expertise. Sanford is the only center in the region to offer it.

A brain aneurysm ruptures about every 18 minutes in the US and nearly half of these cases are fatal.