Endovascular Cerebral Artery Stenting Brain Surgery

Candidates for an Endovascular Cerebral Artery Stenting

Endovascular Cerebral Artery Stenting is a possible treatment option for artery ballooning or an aneurysm, in addition to clipping or coiling. A brain aneurysm is a balloon-like bulge that develops in the wall of its parent artery. As the aneurysm grows, the artery wall weakens and the aneurysm may leak or rupture, causing blood to release into the brain. Most aneurysms are saccular, meaning they are shaped like a balloon with a small neck expanding into a dome. These are the easiest aneurysms to treat. Others have a wider neck or no definable neck, at all, known as fusiform. These are more difficult to clip or coil and may require stenting.

The treatment for an aneurysm will depend on the shape of the aneurysm itself, its location and the overall health of the patient. When deciding upon the course of treatment, the risk of rupture of the aneurysm must be weighed.

What is an Endovascular Cerebral Artery Stenting?

The strategy for treating a ballooning artery will differ if the aneurysm has ruptured versus if it has not. If the aneurysm has ruptured and is bleeding into the brain, known as a subarachnoid hemorrhage (SAH), the timing of the treatment is very important and is usually completed within 72 hours of the first bleed as the risk for repeated bleeding is 22% within the first 14 days. An SAH may also result in narrowing of the artery, or vasospasm. There is a 40% risk of death and 80% risk of disability when an aneurysm ruptures.

If the aneurysm has not ruptured, symptoms may not be present and it may have been detected through routine testing for other conditions. There is less risk associated with an unruptured aneurysm (about 1% risk of rupture per year) but risk may vary depending on the size, shape and location of the aneurysm.

If the aneurysm has not ruptured, certain preparations will be made prior to surgery including relevant tests, stopping medications, refraining from smoking and drinking alcohol, and not eating or drinking after midnight the day before surgery.

During the Endovascular Cerebral Artery Stenting procedure, the patient lies on his or her back and is given general anesthesia and anti-clotting medication. The patient’s head is positioned so that it won’t move during the procedure. The area of injection is prepped and the femoral artery in the groin area is located. The entire procedure typically takes 2-4 hours.

A hollow needle is inserted into the artery and then a catheter is passed through the needle to enter the bloodstream. Dye is injected through the catheter to make blood vessels visible on the x-ray monitor. Using the x-ray visuals, the surgeon guides the catheter through the bloodstream up the aorta, passing the heart and entering one of the four arteries in the neck that lead to the brain. Once the catheter is correctly placed, the surgeon continues to inject the dye to map and measure the arteries and aneurysm.

A smaller catheter is inserted through the first catheter up into the aneurysm, through which the stent is inserted into the artery. A stent is a metal tube that will flex to take the shape of the artery. The surgeon maintains visuals by continuing to inject dye to ensure the placement of the stent. Once the stent is properly placed, the surgeon then releases it. The procedure may also involve packing the aneurysm with coils. The stent, or mesh tube, may be necessary to hold the coils in place and/or divert the blood flow away from the artery ballooning. Once the stent and all coils are placed and the surgeon confirms proper blood flow, the catheters are removed. Pressure is applied to the injection site in the groin area to prevent the artery from bleeding.

If the aneurysm has already ruptured, there is no time for the aforementioned preparations. The patient is stabilized so the providers may locate the hemorrhage. The patient may immediately be taken into the operating room and given medication to decrease blood pressure, put on a breathing machine or sedated.

Results of an Endovascular Cerebral Artery Stenting Procedure

Aneurysms that have been completely diverted are not likely to grow back, however, if the aneurysm was only partially blocked the patient will need to undergo periodic angiograms to ensure the aneurysm is not growing. The aneurysm should be checked regularly to measure regrowth and if a major portion of the aneurysm does regrow, the patient may require another surgery. Additional coils or a clip may be placed to stop the growth. About 5-10% of patients will need a second surgery. Due to the risk of regrowth, surgeons will typically recommend the patient returns after six, 12 and 24 months for an angiogram. If the aneurysm ruptured, the patient should return after three months.

Most patients who undergo an aneurysm clipping, coiling and/or stenting of an unruptured ballooning artery can expect to live normal lives. If the balloon has ruptured, recovery may be more difficult with challenges ranging from minor to more severe. Short-term memory loss and headaches are common. Some deficits may lessen through healing and therapy.

What are the risks of an Endovascular Cerebral Artery Stenting?

Aside from the ever-present risks of surgery, complications of an Endovascular Cerebral Artery Stenting center around the regrowth or rupture of the aneurysm. The risk of vasospasm, stroke, seizure, bleeding and imperfect clip, coil or stent placement are present. Brain surgeries also risk infection, allergic reactions to anesthesia and swelling of the brain.