The Changing Face of Interventional Medicine - The University Of ...

Interventional Neurosurgery:Advances Offer Safe AlternativesPaul Camarata, MD, Chair, NeurosurgeryKoji Ebersole, MD, Director, Endovascular NeurosurgeryDouglas Girod, MD, OtolaryngologyinnovationsRecent advancesin technology andprocedures forusing catheterbasedand other interventional methods inneurosurgery are providing faster, safer, moreeffective treatments. We now have moreoptions for treating certain aneurysms, strokesand other head and neck issues that may havebeen untreatable in the past. The best news,however, is that we have only just begun.The most common interventionalaneurysm repair attempts to “pack” theaneurysm, causing thrombosis that willreduce the pressure and inhibit rupture.The primary method is coiling: platinumwires delivered via catheter to fill theaneurysm as tightly as possible, leadingto clot formation and occlusion.This much less invasive technique workedbest initially on spherical aneurysms withsmall necks. Over time, we found betterways to fit the coils more tightly into oddlyshaped aneurysms and to more effectivelybridge the neck. We also have seen thedevelopment of balloons that inflatetemporarily in the vessel, giving us moretime to make the coils fit complex shapes.And new coiling materials and liquids areable to increase the density of the packing.Still, the recurrence rate with coiling canaverage around 15 percent.Each innovation in materials, proceduresand skill development holds the promiseof even broader application, giving us hopefor continuing to dramatically increasethe survivability of these potentiallydevastating events. This is a review of someof the latest developments in:• Treatment of cerebral aneurysms• Mechanical thrombectomy• Other interventions in neurosurgeryand otolaryngologyEmbolization device virtually erasesevidence of aneurysmAbout 1 or 2 percent of the U.S.population likely has a cerebral aneurysm.That equates roughly to the entirepopulation of the state of Kansas orMissouri. Yet only a very small percentage– about 30,000 of these aneurysms – willrupture each year. Smaller aneurysms areoften better left alone; depending on thepatient’s risk characteristics, they are notlikely to rupture. But larger, more complexaneurysms often warrant treatment.Open surgical treatment of aneurysm,most recently using surgical clips, has beenavailable for more than 60 years and hasproven very successful, with low recurrencerates. But interventional procedures havesurpassed open surgery by two or threeto one over the past 25 years, due to theirattractive minimally invasive nature.The new Pipeline embolization devicerelies on a completely different thoughtprocess. Instead of packing the aneurysmand allowing the blood flow to continuestressing that spot with each pulsation,the Pipeline relies on diverting blood flowaway from the weakened vessel wall.Unlike the usual stent, which is designed tobe as light as possible, the Pipeline is like adense hose, consisting of 48 braided wiresmade of 75 percent cobalt chromium and25 percent platinum tungsten. It is placedinside the vessel from which the aneurysmarises, providing supportive scaffoldingacross the aneurysm neck and keepingthe blood flow in a favored vector down6KUMedInnovationsSummer2013_X.indd 66/13/13 10:09 AM