October 4, 2022 by John Fernandez
A Celebrity’s Bout with Ruptured Aneurysms Puts Spotlight on Treatment Advances, Like Those at Baptist Health Miami Neuroscience Institute
Actress Emilia Clarke, 35, best known for her role in Game of Thrones, recently spoke candidly about her struggles since suffering two ruptured aneurysms over a span of two years starting in 2011. Enduring a second ruptured aneurysm after being surgically treated for the first occurrence is very rare, as advances in safe and minimally invasive procedures have become widely available over the past decade.
If an aneurysm discovered as an incidental finding is at high risk for rupture, treatment is usually recommended – usually either by “open surgery” or a more advanced catheter-based, minimally invasive procedure known as endovascular embolization. The choice of treatment depends on different factors, such as the position, shape, and size of the aneurysm and underlying health issues with the patient.
Endovascular surgeons and neuroradiologists at Miami Neuroscience Institute, part of Baptist Health, have been leaders in pioneering the treatment of brain aneurysms by using the most technologically advanced devices during minimally invasive procedures.
An aneurysm occurs when part of an artery wall weakens, allowing it to abnormally balloon out or widen. With regards to brain aneurysms, unruptured aneurysms are much more common compared to ruptured aneurysms. In fact, the incidence of ruptured aneurysms – a life-threatening occurrence — is about 10 per every 100,000 people. The incidence of unruptured aneurysms is much higher. With advances in treatment and access to healthcare, the mortality rate from ruptured aneurysms have declined in industrial nations over the past 25 years. In the U.S., the median mortality rate is about 32 percent.
In an interview with the BBC, Ms. Clarke talked about a severe headache that suddenly came on during a workout in early 2011, when she had just finished filming the first season of Game of Thrones. A ruptured aneurysm was diagnosed and repaired, but she faced complications of another ruptured aneurysm two years later that she described as more serious.
“The amount of my brain that is no longer usable — it’s remarkable that I am able to speak, sometimes articulately, and live my life completely normally with absolutely no repercussions,” Ms. Clarke told the BBC. “I am in the really, really, really small minority of people that can survive that.”
Italo Linfante, M.D., medical director of Interventional Neuroradiology at Miami Neuroscience Institute and Miami Cardiac & Vascular Institute, both part of Baptist Health, has treated more than 1,000 aneurysms with a procedure called endovascular embolization.
With regards to repairing brain aneurysms, Dr Linfante mentioned: “There are two possible ways to repair an aneurysm. The first goes under the name of microsurgical clipping. In this procedure, the neurosurgeons open the skull and expose the affected blood vessel. They then place a small metal clip on the neck of the aneurysmal sac to stop blood from entering the aneurysm.”
The other procedure goes under the name of endovascular embolization.
Endovascular embolization is performed without open surgery. The patient is placed under general anesthesia, a catheter is inserted into an artery in the groin or in the wrist and then moved up into the blood vessel in the brain. Initially, the operator used to place detachable platinum coils inside the aneurysmal sac through a microcatheter. “Currently, in addition to detachable coils we have several other devices that we could use for the treatment of both ruptured and unruptured aneurysms,” said Dr. Linfante. “Published data on several thousands of patients, including data from randomized controlled trials, show that endovascular embolization is associated with less morbidity and mortality, compared to microsurgical clipping for the treatment of both ruptured and unruptured aneurysms and is therefore the first choice to treat this condition.”
Endovascular embolization has also evolved over the years. “Currently, we have several tools such as balloon, coils, stents, flow diverters and intrasaccular devices that can help us tailor the best treatment to a particular patient,” he adds. “For instance, balloon-assisted coil embolization is very helpful for the treatment of ruptured aneurysms. Flow diverters are very useful for the treatment of blister, large, giant and dissecting aneurysms.”
Nevertheless, despite the advancements in endovascular embolization, microsurgical clipping is still useful and performed in a few selected patients.
“After endovascular embolization, we typically perform follow-up angiography to make sure the aneurysm is secured and stably occluded,” explains Dr. Linfante. “We typically do a follow-up angiography six months after embolization then we do another one year, and then one three years later. The follow-up angiographies are performed to make sure that the aneurysm remains stably occluded and does not grow back. Typically, if the aneurysm is occluded after the three years follow-up angiography, it is extremely unlikely that it will re-grow or it will rupture.”
There is also no question that outcomes of patients with both ruptured and unruptured cerebral aneurysms are better in high volume surgical centers, such as Miami Neuroscience Institute, where a multidisciplinary team of highly skilled and experienced physicians and nurses are used to take care of many patients from the Emergency Department, the Operating Room, the Angiography suite, the NeuroIntensive Care Unit, and the Neurology and Neurosurgical wards.
Baptist Health’s Role in Advancing Treatment of Aneurysms The Institute’s pioneering progress in treating aneurysms include the use of flow diverters, or special tubes, known as stents, that prevent blood from flowing to an aneurysm, reducing the risk of rupture. Baptist Health South Florida was the first site in South Florida to use the Pipeline Flex Embolization Device with Shield Technology to treat aneurysms. Baptist Health was also first in S. Florida to use the Woven EndoBridge (WEB) device placement for aneurysms.