Stents Can Prevent Aneurysm Recurrence

Stents added to coiling brain aneurysm repair could lower recurrence

(RxWiki News) A new less-invasive operation to repair brain aneurysms has a significant drawback -- about a third of patients experience a recurrence. Adding a simple stent may prevent that.

Adding a stent after using a minimally invasive coiling procedure could prevent lethal blood vessel bulges in the brain from happening again. The procedure could aid 30,000 in the United States diagnosed with a cerebral aneurysm each year.

"Consider the benefits of various aneurysm procedures."

Dr. Alex Coon, leader of the study and assistant professor of neurosurgery, neurology and radiology, and director of endovascular surgery at the Johns Hopkins University School of Medicine, said  that knowing what can prevent recurrence will help surgeons and patients make better informed decisions about procedure choice.

Aneurysms are usually repaired through an operation in which surgeons remove a portion of skull and slice into the brain to reach the affected blood vessel before placing a metal clip on the ballooning blood vessel.

In recent years, many surgeons have instead opted to use a coiling method in which they thread a platinum wire into a small groin incision, pushing it through the body's blood vessels to locate the bulging vessel. Wire is then packed into the bulge, with a natural clotting reaction cutting it off.

The coiling method has a lower risk of infection and recovery times measured in weeks instead of months. But one problem is that about at third of patients who receive the coiling method experience recurrence of the aneurysm. Traditional aneurysm surgery has a 2 percent recurrence rate.

But surgeons believe that inserting a stent in the blood vessel near the neck of the aneurysm may cut the high recurrence rates. The stent allows surgeons to prop open the affected blood vessel and better pack wire into that bulge.

During the study, Dr. Coon and his research team reviewed medical records of 90 patients who had aneurysm repair through the coiling method at John Hopkins Hospital between May 1992 and March 2009. A stent was used in about a third of those operations.

After two years of follow up, investigators discovered that aneurysms recurred in more than 40 percent of patients who did not have stents. The recurrence rate in patients who received stents was about 15 percent. Both groups had about the same number of complications.

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Review Date: 
July 28, 2011