February 21, 2019 by John Fernandez
Stent-Like ‘Flow Diverter’ is Saving Patients with High-Risk Brain Aneurysms
Yadira Erriguible, 66, recalls suddenly losing something most people take for granted. “I lost my sense of taste and smell,” she says. “This was in November 2017. My friends insisted I go to an ENT (ear nose & throat physician) because this wasn’t normal for my age.”
A few doctor visits and imaging tests later, Ms. Erriguible learned she had three unruptured brain aneurysms — bulges in the walls of blood vessels — which often don’t produce any symptoms. But they can act like ticking time bombs and they can cause serious harm or death to a patient if they burst, says Ms. Erriguible’s doctor, interventional neuroradiologist Italo Linfante, M.D. In her case, the only other symptom was an occasional headache.
When brain aneurysms need repair, experts at Baptist Health Neuroscience Center and Miami Cardiac & Vascular Institute work together to fix them in a minimally invasive manner, without cutting open the skull. They do this with the help of a relatively new stent-like device, the flow diverter.
The Baptist Health News Team hears from interventional neuroradiologists Italo Linfante, M.D., and Guilherme Dabus, M.D., and patient Yadira Erriguible about the new “flow diverter” procedure that successfully treated her brain aneurysms. Video by Dylan Kyle.
For Ms. Erriguible’s first procedure to eliminate the largest aneurysm, Dr. Linfante utilized a more commonly used platinum coil to induce clotting (embolization) of the aneurysm and hopefully prevent blood from continuing to grow the bulge- or balloon-like aneurysm. The other two smaller aneurysms would be monitored over time.
In a follow-up visit this past December, Dr. Linfante “found that the two small aneurysms had gotten bigger and that my artery was very weak,” says Ms. Erriguible. “He decided to use a new procedure in order for the artery to be stronger and this would eventually eliminate the aneurysms.”
The new procedure involved the latest generation of “flow diverters” – a sort of clever stent which was recently approved by the U.S. Food and Drug Administration to treat unruptured “large and giant wide neck” aneurysms, says Dr. Linfante, who is medical director of Interventional Neuroradiology and Endovascular Neurosurgery at the Institute. For the first time, patients at high risk with bulging aneurysms can be treated with this newest flow diverter, he says.
“Once this device is implanted, the artery is reconstructed from the inside,” explains Dr. Linfante. “It’s a major advancement in the treatment of aneurysms. We’ve been using a previous generation of this ‘flow diverter’ device for years, and we’re the first one in Florida to use this new generation of the flow diverter that was just approved.”
Flow diverters are made with more dense mesh than the traditional small tubes used to restore blood flow in narrow or weak arteries. They are part of a new strategy away from the more traditional methods of utilizing stents or coils, procedures aimed directly at the aneurysm itself.
“An aneurysm forms when a weak spot develops in a blood vessel and starts to bloat out — basically like a bulge or balloon that forms,” said interventional neuroradiologist Guilherme Dabus, M.D., who assisted Dr. Linfante. “Over time, the aneurysm may continue to grow, like in the case of Yadira, and sometimes they just burst. When aneurysms burst, the risk of dying or suffering severe disability is very high. It’s very important that these patients seek immediate medical attention.”
If an aneurysm is detected, but has not ruptured, there are more options: either treatment or observation. The minimally invasive procedures, usually involving coils or mesh stents, are used to promote clotting and close off the aneurysm with a very high success rate of more than 90 percent. The devices are placed via a catheter that snakes through a blood vessel from the groin to the brain.
Patients with “giant” aneurysms faced extremely risky surgery before the advent of the flow diverter, says Dr. Linfante.
“The whole artery is completely blown out, and completely dilated,” explains Dr. Linfante. “Surgery is virtually impossible because you would have to reconstruct the whole artery. The way it was done in the past was to close the whole artery and do a bypass. Of course, this surgery is associated with severe mortality. But the flow diverters are perfect for this type of aneurysm.”
Most aneurysms develop after the age of 40, but are most prevalent in people ages 35 to 60. Most patients are lucky to have the aneurysms incidentally found through a CT scan or MRI after complaining of other possible symptoms, primarily bad headaches.
“Every day I get better,” says Ms. Erriguible. ‘I’m very grateful. I feel I can live a better life now. I’m looking forward to having a happy life.”