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Data
from the International Study of Un-ruptured Intracranial
Aneurysms (ISUIA) provided substantial new evidence showing
that aneurysm size, location and a previous history of a
ruptured aneurysm are the best predictors of future aneurysmal
ruptures. The findings provide physicians with new insight
regarding the risk-benefit of aneurysm repair versus conservative
treatment, such as monitoring the aneurysm and observation
of the patient.
An
aneurysm is an area of weakness in a blood vessel, which
usually enlarges over
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John
C. Chaloupka, MD
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time. When a brain aneurysm ruptures, blood flows into the
space surrounding the brain (the subarachnoid space), resulting
in a subarachnoid hemorrhage (SAH), the deadliest form of
stroke. SAH affects approximately 35,000 individuals each
year in the United States. About 50 percent of patients
with ruptured brain aneurysms will die within the first
30 days. Of those who survive, about half will suffer from
severe neurological injury. It is estimated that up to 17
million people have or will develop un-ruptured aneurysms.
The
ISUIA data showed that patients with multiple un-ruptured
aneurysms and a previous history of rupture from a separate
aneurysm were at greater risk for a second hemorrhage. Some
of these individuals may benefit from interventional treatment
of even smaller aneurysms depending on their location.
The
researchers repaired the aneurysms with either a surgical
or an endovascular approach. The surgical procedure, called
neurosurgical clipping, involved performing a craniotomy
(removing a section of the skull) and placing a surgical
clip at the neck of the aneurysm. Endovascular treatment
entails filling (occluding) the aneurysm with detachable
platinum coils. The specialist inserts a catheter into an
artery in the patient's leg and navigates it through the
vascular system under X-ray guidance, into the head and
into the aneurysm. Tiny platinum coils are then threaded
through the catheter and deployed into the aneurysm, obstructing
blood flow into the aneurysm in order to prevent rupture.
The
study showed that disability and death rates following endovascular
treatment were lower than those for surgery at both one
month (9.1 percent endovascular versus 13.2 percent surgical)
and one year (9.5 percent endovascular versus 12.2 percent
surgical).
"Endovascular treatment such as 'coiling' resulted
in less death and disability, despite the fact that the
endovascular patient group was older and had more extenuating
risk factors," explained John Chaloupka, M.D., UI professor
and director of interventional neuroradiology at UI Hospitals
and Clinics. "Further, since endovascular treatment
is minimally invasive, patients typically experience less
overall risk, less pain and shorter recovery times. These
are very promising results."
The
lifetime health care cost of caring for people with un-ruptured
aneurysms in the brain in the United States is estimated
at $522 million annually. When a SAH occurs, the lifetime
health care costs of patients rise to approximately $1.8
billion each year, according to an article published in
the New England Journal of Medicine.
University of Iowa Health Care describes the partnership
between the UI Roy J. and Lucille A. Carver College of Medicine
and UI Hospitals and Clinics and the patient care, medical
education and research programs and services they provide.
Visit UI Health Care online at http://www.uihealthcare.com/.
STORY
SOURCE: Joint Office for Planning, Marketing and Communications,
University of Iowa Health Care, 200 Hawkins Drive, Room
8798 JPP, Iowa City, Iowa 52242-1009.
August
27, 2003
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