Loma Linda University Health is the first in the Inland Empire to treat complex wide-neck aneurysms using a new endovascular technology called the Woven EndoBridge Device (WEB). This minimally-invasive, endovascular treatment offers a new approach to treating complex brain aneurysms.
A wide-neck aneurysm is a bulge within a blood vessel that is wider than 2 millimeters at its base.
This new type of procedure involves navigating the device to the brain vessels using catheters traversing through the groin. The device is then deployed inside the aneurysm, where its web- or basket-like configuration confines into the shape of the aneurysm, effectively stopping blood from flowing into the aneurysm and preventing rupture. The treatment can be performed in as little as a few hours and allows patients to return to normal activities sooner than with conventional surgical treatments.
“From a physician’s standpoint, complex wide-neck brain aneurysms are difficult to treat, and ruptured aneurysms are even more so,” said Ramachandran Pillai Promod Kumar, MBBS, M.Ch, a dual trained cerebrovascular neurosurgeon who performed the surgery. “This procedure offers new possibilities by eliminating open surgery and optimizing the procedure to a single device. It effectively creates a whole different outcome for patients who have ruptured and unruptured aneurysms.”
This procedure could potentially offer alternative endovascular options, particularly for patients in whom surgical clipping carries high risks.
Pillai said there are two methods to treating complex brain aneurysms. The more recent offering is endovascular coiling, where a small catheter is placed through the groin artery and then guided to the affected brain artery. Once in place, the microcatheter releases the coil into the blocking blood from entering the aneurysm. Endovascular coiling is effective for smaller aneurysms. Pillai said aneurysms considered wide-neck run the risk of the coil not holding in place. In the cases where the coil does not take, a stent may need to be applied, which can run the risk of blood clotting and circulation difficulty.
Pillai said the conventional method of treating wide-neck aneurysms is open-brain surgery, especially in a setting of brain hemorrhage, which involves exposing the blood vessel through surgery and placing a clip across the neck of the aneurysm.
“Open-brain surgery can be much more complex, with a longer recovery period, and an increased chance of morbidity,” Pillai said. “The minimally invasive nature of this new procedure could potentially replace surgical clipping. We’re changing the way we treat the patient and their recovery.”
Pillai performed the surgery on patient who was experiencing painful headaches for more than six months. Pillai said the patient was an ideal candidate for the new procedure because the patient had a complex wide-neck aneurysm at the center of the base of the brain — a difficult place to access for open surgery. Due to the complexity and shape of the aneurysm, traditional endovascular coiling may not have worked.
The National Institute of Neurological Disorders and Stroke estimates that 3% to 5% of Americans will suffer a brain aneurysm in their lifetime, while 30,000 Americans each year will suffer a rupture. When a brain aneurysm ruptures, the blood flow to critical areas of the brain can be disrupted. In some cases, this can lead to tissue death and, depending on the size and location of the aneurysm, it can also be life-threating.