New treatment option for ruptured brain aneurysms

Researchers in Finland have identified an effective new treatment option for patients who have suffered a ruptured brain aneurysm, a potentially life-threatening event. Results of the new study on stent-assisted coil embolisation were published today in the online edition of Radiology.

An aneurysm is a bulge or sac that develops in a weak area of a cerebral artery wall. Subarachnoid haemorrhage occurs when an aneurysm ruptures, diverting oxygen-rich blood from vital areas to the space between the brain and the skull. The ruptured vessel can be repaired surgically or through a minimally invasive procedure called embolisation, in which the sac is filled with metal coils in order to prevent repeat bleeding from the aneurysm and to restore normal blood flow in the artery.

'The treatment decision is complicated in cases of acutely ruptured aneurysms,' said the study's lead author, Olli Taehtinen, M.D., assistant professor of radiology at Tampere University Hospital in Tampere, Finland.

Embolisation treatment of cerebral artery aneurysms is becoming increasingly favoured over surgical repair, especially when the patient is older or in poor medical condition. However, embolisation is challenging when the neck of the aneurysm is wide, because the metal coils have a tendency to protrude out of the sac into the artery. A balloon-tipped catheter threaded to the site of the aneurysm can sometimes, but not always, solve the problem.

'When the width or neck of the bulge is particularly wide, aneurysms can be difficult to treat surgically or with balloon-assisted embolisation,' Dr Taehtinen said.

The researchers studied the effects of stent-assisted embolisation in 61 patients, including 41 women and 20 men, who were treated for subarachnoid haemorrhage at three Finnish hospitals over a 4.5-year period. According to Dr Taehtinen, the study represents the most extensive analysis to date of stent-assisted embolisation treatment of acute subarachnoid haemorrhage.

In the study, interventional radiologists performed coil embolisation by first placing a stent, a small wire mesh tube, over the neck of the aneurysm to help keep the coils within the aneurysmal sac. The procedure was a technical success in 44 (72 percent) of the 61 patients. Adequate blood flow was restored in 39 (64 percent) of the patients.

'Our study shows that stent-assisted coil embolisation is a feasible treatment option for ruptured brain aneurysms that are difficult to treat surgically or with balloon-assisted embolisation,' Dr Taehtinen said. 'Stent-assisted embolisation may offer an important addition to the treatment repertoire for these critically ill patients.'