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Health Information Navigating the Brain's Curves

A breakthrough treatment for aneurysms

If you think it's tricky navigating the sharp curve on Lake Shore Drive at Oak Street, imagine trying to negotiate your way through the twists and turns of the brain. The brain consists of cells folded in wavy layers, with blood vessels winding throughout. In this curving environment, medical treatments can be challenging.

"Navigating inside the brain's blood vessels during surgery is a bit like driving down the expressway," says Demetrius Lopes, MD, a neuroendovascular surgeon at Rush University Medical Center. "One second you're on the straightaway, and then suddenly you encounter curves."

Curves ahead 

Complicated as it is, surgeons operate successfully in the brain every day. For instance, they repair aneurysms by threading catheters and other devices through the curves in the brain's blood vessels.

Aneurysms are blood-filled bulges in brain vessel walls that can lead to neurological impairments, stroke and even death. They occur when the vessel weakens and balloons due to the pressure of flowing blood.

Large (10 millimeters or more in diameter) and giant (25 millimeters or more in diameter) wide-necked aneurysms are particularly dangerous. Because of their sheer bulk, they are more likely to break free or burst, leading to a stroke, or to compress nerves and surrounding brain tissue, resulting in pain and facial paralysis.

These aneurysms have been notoriously difficult to treat, even with methods that work well for smaller aneurysms, and they have a high rate of recurrence, leaving these patients with few options.

Breakthrough treatment

Now, however, Rush is able to offer treatment for these aneurysms with a revolutionary new piece of equipment called the Pipeline Embolization Device.

"With Pipeline, we have basically created a new blood vessel, which we can place inside the current weakened vessel," says Lopes, who assisted on the development and initial clinical trials of the device. "It behaves like the healthy original."

The device consists of a crimped mesh tube, which doctors place inside the blood vessel using a fine, flexible catheter that can wind through the brain. Once in place, the device expands and shapes itself to fit the vessel's natural curvature.

Researchers had to invent a material for this device that not only could curve to fit the brain blood vessels, but that also was strong enough to block off the aneurysm and divert blood flow away from the weakened area of the vessel, Lopes says. No previous device or treatment had been able to do all three, but clinical trials proved Pipeline was up to the challenge.

"The data from the trial was truly convincing," says Lopes. "The rate of recurrence of giant aneurysms dropped from 30 percent to less than 5 percent."

After FDA approval, Rush became the first site in Illinois to offer Pipeline, providing an option for patients who once would have been out of options.

"This device is something that was once unthinkable," he says. "We are now able to save patients who, in the past, we might have lost."

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Discover Rush Winter 2011
Navigating the Brain's Curves

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