Critical Care for Cerebral Aneurysms

Health First’s Dr. Nana Amiridze, the county’s first and only interventional neuroradiologist, performs coiling procedure on local artist

Melbourne artist Sue Doucette was glad that Health First Physician Nana Amiridze, M.D., Ph.D., Brevard’s first and only interventional neuroradiologist, was available when it was discovered she had a bleeding aneurysm. The symptoms are few, if any, with cerebral aneurysms… at least until they rupture.

Just two days after Thanksgiving last year, Doucette found herself in a fight for her life. Intense, pounding headaches and vomiting signaled to Doucette’s loved ones that something was very wrong with her. At Holmes Regional Medical Center, Doucette was diagnosed with a ruptured cerebral aneurysm, a life-threatening cerebrovascular disorder that often exacts a high price from patients. A rupture of a cerebral aneurysm occurs because the walls of a cerebral artery or vein are weakened, causing a ballooning of the blood vessel. Aneurysms usually develop at the structurally more vulnerable fork where a blood vessel branches out.

With a family history of aneurysm, Doucette was a prime candidate for the disorder, which also affects individuals with pre-existing conditions such as high blood pressure, head trauma or atherosclerosis, also known as fat deposits in the arteries. Other risk factors include diabetes, complications from some types of blood infections, alcoholism and nicotine usage. Women are more prone to this type of aneurysm, as are older adults. About 27,000 cases are reported annually.

CEREBRAL ANEURYSMS TAKE NO PRISONERS

Half of all patients who suffer a cerebral aneurysm will die due to blood seeping into the brain. Patients who survive the aneurysm still are not out of the woods, for a quarter of them will die or lose significant function because of complications.

Vasospasm, a narrowing of the blood vessels, often accompanies cerebral aneurysms and causes symptoms of stroke because the blood vessels are not delivering an adequate supply of blood to the brain. In a classic case of feast or famine, cerebral aneurysms initially swamp the brain with blood. Later, complications disrupt the supply of adequate blood to the brain.

“Vasospasm may be difficult to handle,” says Dr. Amiridze. “In some cases, we have to perform additional complex procedures on the brain vessels to stretch arteries from inside with tiny balloons to prevent stroke and permanent damage to the brain. We had to take Sue three times for this procedure during two weeks after her initial bleeding.

“As many as 46 percent of survivors of subarachnoid hemorrhage may have long-term cognitive impairment.”

Since Doucette is an artist and a writer, it was critical that treatment attempt to preserve as many of her functions as possible, in particular the right-hand function and her ability to speak.

At Holmes Regional Medical Center, CT imaging revealed a cerebral aneurysm with subarachnoid hemorrhaging, or acute bleeding in the head, because of the aneurysm’s rupture.

“Her condition was poor,” says Dr. Amiridze.

Time is of the essence with a ruptured aneurysm, so Basil Theodotou, M.D., a neurosurgeon, provided the first order of treatment by emergently draining the blood threatening to drown Doucette’s brain.

COILING PROCEDURE STOPS BLOOD FLOW

Dr. Amiridze then proceeded to block blood flow into the aneurysm to prevent recurrent bleeding by treating the aneurysm with coiling. With this minimally invasive endovascular surgical procedure, the physician inserts a catheter containing tiny platinum coils into the femoral artery in the patient’s leg and guides it to the aneurysm in the head, where the coils are released to stop the blood flow.

Coiling or surgical clipping are the two primary options for treating cerebral aneurysms. Surgical clipping entails a craniotomy in which a section of the skull is removed and then replaced after a clip halts blood flow at the bottom of the aneurysm. Coiling is done without cutting open the skull to expose the brain. In Brevard County, only Holmes Regional Medical Center offers both procedures. In addition to Dr. Theodotou, Dr. Amiridze is working closely on every case with two other experienced neurosurgeons, Mark Fulton, M.D. and Jonathan Paine, M.D.

“Sue was very lucky and lost none of her functioning. Waiting until the aneurysm ruptures is not advisable,” says Dr. Amiridze, who recommends a baseline MR imaging of the brain vessels for patients with a family history of aneurysms.

“The old mentality of holding off on treating small aneurysms no longer holds true,” she says.

By taking preventive action and treating the aneurysm before it ruptures, the patient stands a much better outcome for recovery. Patients are heeding the advice. In Dr. Amiridze’s practice, 50 percent of cases involve the prophylactic closing of the aneurysms.

“The outcome is 95 percent perfect recovery,” says Dr. Amiridze.

Doucette has returned to normalcy after her ordeal, and has returned to painting and writing. “I still get headaches here and there, but I didn’t lose any function,” she says.

Leave a comment

You must be logged in to post a comment.