This morning we met with my doctor to discuss the results of my angiogram, his findings, his recommendations, and the next course of action.
In comparing the most recent angiogram with the angiogram from 2016, there are “significant changes” in the bloody remnant in the neck of the aneurysm.
This finding gave my doctor “anxiety that it is at risk” of rupturing in the future again.
Place a flow diverter inside my existing stent to prevent more blood from getting into the neck of the aneurysm.
They may insert and expand a balloon first to push back any “tines” from the original stent to allow the new flow diverter to be positioned better.
The Surpass flow diverter is a more flexible stent that should adhere better to my “ugly” and “challenging” arterial structure around the aneurysm.
It’s an endovascular procedure, so not open head surgery.
Bringing in an additional doctor with knowledge of this procedure and flow diverter to assist if need be.
To go ahead with this procedure here at Maine Med.
Will be put on blood thinners (Plavix and full-strength aspirin) the week prior to procedure then remain on both for 6-months after.
Procedure could be as early as March.
There is a good video about administering the Surpass flow diverter on this page, although it doesn’t show it being deployed inside another diverter: Surpass Flow Diverter
I was surprised to read on my blog that I’ve been dealing with the stress of this darn remnant for 11 years now. When the re-coil and stent didn’t do the job, the next course of action would be the stent within a stent. If THIS doesn’t work, there is a possibility we could sacrifice that entire section of artery, but I’m counting on it working so let’s not even go there.
Making this decision with Dave by my side gave me a sense of relief. Relief in knowing I’m doing something about it and there is a plan of action. I have great faith in my doctor and his familiarity with my case, my brain, and this particular brain aneurysm for the past 11 years. I know he wouldn’t make a recommendation unless he felt there was a good chance of success. And so far, he hasn’t been wrong.
That’s right. I’ve had 10 angiograms. I’m so well-versed on this procedure that the nurse said I could do my own IV Friday morning. I respectfully declined and left the experts to attend to that task.
The procedure was rescheduled for very early in the morning. We had to be at the hospital at 6:30 am, which meant leaving our house at 5 am…which in turn meant the alarm went off at 4 am. I call that the pre-butt-crack of dawn.
As usual the entire staff in radiology at Maine Medical Center is top-notch and I was well taken care of. The only different this time from the last 9 angiograms is that Dave was not allowed in the hospital due to the high numbers of Covid19 STILL active in Maine.
It was very difficult for Dave to not be with me and it was very odd not having him with me. He’s usually a chatty-Kathy with all of the nurses, doctors, and attendants and that creates a good distraction for me. This time it was just me laying there by myself waiting for things to happen. Not awful, just odd. And of course, my thoughts went to those families around the country and around the world who weren’t able to be with their dying relatives and how awful that must have been and continues to be.
My sweet anesthesiologist Ally (not sure about the spelling) was great in listening to me when I expressed my concerns about pain when the catheter is inserted and afterwards if a plug is needed in the incision site. Thankfully, because this was just a diagnostic procedure and there were no implements being entered into my brain, the plug was not needed. And because she administered some pain killer before the catheter was used I never felt it going in and didn’t even realize the actual procedure had started! That’s a first!
I kept waiting for some verbal communication that the catheter was being used and things were getting started, but it never happened. I moved my head slightly, which is a big no-no and the doctor immediately said “Don’t move you head, Heidi!”. It was only then that I realized, “Oh, things have started!”.
The reason for this angiogram was to get a clearer set of images of my first brain aneurysm and determine if the change seen on the MRA from December is dramatic or something small that isn’t a concern right now. He also took some 3D images, which are fascinating to see and can be compared to the series of images taken in 2015.
The contrast dye entering your brain is an odd and uncomfortable feeling. Kind of painful, but not really and it only last a brief time. The 3D imaging is also odd. Not really painful, just a strange sensation and you see little flashing sparkles. At least I think that was the 3D…I may be confusing the dye and the 3D. Hey, I was a little drugged. Both experiences are strange, but thankfully brief.
The good news during the procedure was the declaration from Dr. Ecker that he had a good look around everywhere else and there were no NEW brain aneurysm. Yes, that’s great news! But I was still concerned about the problem child and he quickly indicated that he really wanted to compare the images taken today with those from 2015 before giving us any kind of indication about what’s going on.
My post-op recovery from the angiogram went very well, with no issues. Again, the nursing staff are terrific. One has to lay flat for at least two-hours afterwards to give the incision site time to heal and for the team to make sure there are no issues with blood flow. I don’t recall so much attention being paid to the pulse in my feet before. I know it’s been done before, but it just seemed really extensive this time with two black marks being drawn on each foot, that are still not coming off two days later.
Post-op was strange without Dave there to grab my purse and cut my sandwich…grab water for me, help me balance to put on my socks, etc. The nurses were very helpful as usual and they grabbed my cell phone out of my purse for me so I could send Dave a photo and a text to let him know I was doing okay and when he could meet me outside to go home.
Because I don’t know what’s going on yet, I can’t report much today. The doctor did call Dave afterwards and indicated once he compares images, he may be contacting other doctors he knows around the world to discuss putting a modern stent inside an older stent. It’s not that common, but it has been done and he wants to get their input. I respect that and glad he has some terrific colleagues out there from around the world to draw on their expertise.
Dave also said he told him the artery where my brain aneurysm is, is a challenge due to it’s shape and form. Goody. I know Dr. Ecker has spoken about doing some kind of bi-pass basically shutting down that section of the artery if blood flow can continue to flow normally without it. That would need a BOT or balloon occlusion test….something we were going to do many years ago, but decided not to. It may be needed now. I just don’t know yet.
We got home from the hospital about mid-afternoon and I was exhausted. I lay on the couch resting my leg and fell asleep many times. Also drank a lot of water to get the contrast dye and the happy meds out of my body. I had a slight headache for a day and a half, and the incision site on my groin was a little sore. They must have had to pinch my skin, as a lovely black & blue mark developed well below the site. It’s a little sore, but already feeling better. Still not exerting myself too much and taking it easy for another day. I’m an expert at that.
So, I sit and wait for word. This isn’t anything new for me, and that’s frustrating because this same aneurysm is still being an issue 15 years later. I’m hopeful recent medical technology and procedures can assist in making a more permanent resolution.
In the meantime, I continue to LIVE with brain aneurysms. Stay tuned and thanks for the kind thoughts and prayers I have received on social media.
My follow-up cerebral angiogram has been rescheduled for this Friday, January 28th. This will be my 10th angiogram. Light me up!
The angiogram will give my doctor a clearer view of what’s happening within the neck of my first brain aneurysm. His notes after my last visited stated: “She presents a challenge as she has a stent/coiled aneurysm with recurrence.” And the desired treatment he’d like to perform is also a challenge due to the stent. Goody! So glad I could be that special case again.
So, we get the angiogram done and go from there. Keep calm and carry on…or something like that.
The follow-up with my interventional radiologist/neurosurgeon confirmed the MRA I had in December showed additional development of more blood getting into the neck of my first brain aneurysm – AGAIN. We went through these discussions back in 2015 when that remnant first showed up. I decided to kick the can and watch, wait, and continue to monitor it. After five years, it appears there is more blood now.
The doctor wants me to have another angiogram to get a closer look and determine if we need to take action now. This is not the way I had hoped to start the new year. It may be nothing alarming…or it might be.
I created the graphic below to present, in it’s simplest form, what’s happening. This is the first aneurysm that ruptured in 2006. It’s 11mm or about 1/2” in diameter.
There were 16 coils inserted into the aneurysm in 2006.
Those coils healed and clotted, preventing blood from getting back into the aneurysm.
Five years later, the coils either started to compact, the shape of the aneurysm and neck of the aneurysm changed, or a combination of both occurred, This allowed some blood to get back into the neck of the aneurysm.
4 more coils were inserted (for a total of 20) and a stent was placed across the bottom of the neck in the artery in 2011.
In 2015, during annual checkups, it was discovered more blood was starting to get back into the aneurysm again.
We decided to “wait and watch” the remnant of blood for future development.
Now in 2022, we’re discussing the fact that it appears MORE blood is getting into the aneurysm after six years of stability. This is also a brain aneurysm that has already ruptured once.
During the last 15 years, I have had to endure a couple of “watch and wait” periods for both my aneurysms. There is always a nagging worry that lays there asking those probing questions: Is it growing? Has there been any change? Am I making it worse? Could something I’m doing make it rupture? Is that headache a sign that something is wrong?
Anyone who is living with brain aneurysms knows that worry. Telling me to “Not worry about it” is far easier said than done.
The good news is that I feel fine. I just hope I can stay that way. 🤞