1、IMAGE GUIDED THERAPIES Media Briefing June 19, 2003,Brain Aneurysms Successfully Treated Without Open Surgery,V A S C U L A R D I S E A S E,Jacques E. Dion, M.D. Emory University Hospital,S p o n s o r e d b y t h e,Radiological Society of North America,Brain Aneurysms Successfully Treated Without O
2、pen Surgery,Jacques E. Dion, M.D., FRCP (C) Professor of Radiology & Neurosurgery Director, Interventional Neuroradiology Emory University Hospital Atlanta, GA,History of Coiling,1987-1989: Dr Guido Guglielmi (University of Rome) visits Dr Viuela (Interventional Neuroradiologist) at UCLA and researc
3、h work on coiling concept starts 1989: Dr Guglielmi comes permanently to UCLA 1989-1990: Bench and animal research March 6, 1990: First clinical use of Guglielmi Detachable Coil FDA approval in 1995,International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coilin
4、g in 2143 patients with ruptured intracranial aneurysms: a randomized trial,The LancetVol 360, October 26, 2002,ISAT,A recent large prospective study of 2143 patients with ruptured aneurysms who could equally be treated with clipping or coiling had to be prematurely stopped short of planned enrollme
5、nt of 2500 patients because the coiled patients suffered significantly less death and dependency as compared to clipped patients (6.9% absolute difference, 22.6% relative difference) and it would have been unethical to continue the study,What Is An Aneurysm?,A cerebral aneurysm is a bubble like outp
6、ouching from an artery which predisposes its carrier to cerebral hemorrhage and stroke,Images Frank H. Netter, CIBA Collection of Medical Illustrations,Aneurysm Demographics,Aneurysms are found in 2-5% of the population There are as many as 27,000 aneurysms that could be diagnosed and treated per ye
7、ar in the U.S. They are more common in women (Sharon Stone had an aneurysm that was treated with coils by an interventional neuroradiologist) The annual rupture rate is approximately 1.5% Rupture of an aneurysm results in approximately 50% mortality and 25% stroke incidence,Aneurysm Facts,Factors be
8、lieved to contribute to brain aneurysms: Smoking Hypertension Traumatic head injury Alcohol use Use of oral contraception Family history of brain aneurysms Other inherited disorders: Ehlers syndrome, polycystic kidney disease, and Marfan syndrome,Aneurysm Facts,Symptoms of ruptured aneurysms: The wo
9、rst headache of your life Localized and intense headache Nausea and vomiting Stiff neck or neck pain Blurred or double vision Pain above and behind eye Dilated pupils Sensitivity to light Loss of sensation,Aneurysm Therapy,Surgical clipping (approximately 60-65% in the United States) Endovascular co
10、iling (approximately 30-35% in the United States) In certain countries such as Finland, Great Britain and France, close to 90% of aneurysms are treated with endovascular coiling After the release of the ISAT results, the percentage of aneurysm patients treated with coiling in England went from 40% t
11、o 90%,Aneurysm Clipping,Done under general anesthesia through a craniotomy (hole in the head) The brain is gently retracted in order to gain visual access to the aneurysm A clip is placed at the neck of the aneurysm 1 week in the hospital 1 month recovery,ANEURYSM COILING,A minimally invasive proced
12、ure usually performed under general anesthesia by an interventional neuroradiologist A very small plastic tube (microcatheter) is threaded from the groin to the aneurysm in the brain, and fine platinum threads (coils) are inserted into the aneurysm to fill it from the inside, much like filling a pot
13、hole The catheter is then removed and the small groin incision covered with a Band-Aid For an unruptured aneurysm, the patient is discharged home within 24 to 48 hours,Pros and Cons of Coiling,PROSMinimally invasive Short recovery Safer than surgery Cheaper than surgery,CONS Shorter track record Pos
14、sibly less durable Requirement for follow-up angiography,The Future,Increased percentage of patients treated with coiling, in large volume referral centers Use of adjunctive maneuvers increases the percentage of aneurysms treatable with endovascular techniques Increased efficacy of coiling therapy (
15、new, bioactive materials, tissue healing strategies) Development of non-invasive follow-up techniques with CT or MR scanning Better educated population will actually demand availability and discussion of both endovascular coiling and surgical clipping options,Stent + Coil,Wide neck mid basilar aneur
16、ysm,Stent + coils,Hydrocoil,Matrix Bioactive Coil,Take Home Points,Endovascular coiling of aneurysms is available in over 200 hospitals in this country Approximately 200,000 patients in the world have benefited from endovascular coiling since its inception in 1990,Take Home Points,The ISAT study rec
17、ently demonstrated a substantially better clinical outcome (22.6% less death and dependency relative difference, 6.9% absolute difference) in patients with ruptured aneurysms treated with endovascular coiling compared to patients treated with surgical clipping,Take Home Points,All patients with aneu
18、rysms should be informed of the availability of both endovascular coiling and surgical clipping by a neurosurgeon and an interventional neuroradiologist The death and complication rate for aneurysm therapy is dramatically reduced in high volume centers that offer both surgical clipping and endovascular coiling,Information and Links,American Society of Interventional and Therapeutic Neuroradiology (ASITN),http:/www.asitn.org/,
