Well, after meeting with my neurosurgeon this morning we have decided to kick the can for another year on the blood remnant in my large brain aneurysm. Yes, it’s there, but it doesn’t pose any immediate risk at the moment – they think.
Options currently presented are:
- Do nothing and observe with periodic angiograms/MRA’s.
- Insert more coils (I have 20 already) into the aneurysm in hopes no more blood gets in.
- Block off the affected artery and see if the blood flow reverses.
- Place the relatively new Pipeline™ Embolization Device INSIDE the existing stent that was place in the artery in 2011.
Here is how we’re addressing each option:
Watch & Wait: Simply monitor the remnant with periodic angiograms and/or MRA’s. Then if it appears it IS growing and more blood is getting back into the aneurysm, THEN we act. It could do nothing for 10 years, or it could double in size by next year.
More Coils: I already have 20 coils and a stent that is supposed to be blocking blood getting into the brain aneurysm. Obviously, they’re not doing their job as hoped and expected.
Sacrifice the artery where the aneurysm is & reverse blood flow: This procedure will require doing a balloon occlusion test first to determine if my vascular system can handle the blood flow being shut off. IF the balloon test is successful, then I would be a candidate for having that “diseased” part of my artery completely filled with coils and the blood flow would reverse. I’m still trying to understand how it all works.
The Pipeline inserted inside existing stent: The doctor had done some research and this specific procedure has only been done ONCE, at least in the U.S. that he is aware of. Not exactly a glowing recommendation. Even one of the most renowned neurosurgeon’s in the country has shied away from doing it.
It’s pretty safe to say we have ruled out options 2 and 4. Adding more coils doesn’t seem like a more durable option at this point and even though the Pipeline has been used VERY successfully throughout the entire country, including here in Maine by my doctor, the lack of data and positive feedback on inserting one into an existing stent doesn’t bode well for its use in my specific situation. I’d rather not be a test subject unless all other options have been exhausted.
So, we’re going to do a combo of 1 and 3. Well…at least #1 at this point.
I’ll have an angiogram next Spring AND have the balloon occlusion test done at the same time. There are four main arteries supplying blood to your brain. In most people, there are links between these four arteries that allow for one of the arteries to be blocked without significantly affecting the amount of blood reaching the brain. The balloon occlusion test is usually done if there is an abnormality (in my case, an aneurysm) in one of the four main arteries. It is a way to see whether one artery can be temporarily or permanently blocked without significantly affecting the level of blood in your brain. An X-ray and a special dye are used to create images of your arteries and a small balloon, which when inflated will temporarily block your artery. Sounds scary, but if you’re on the table in the hospital already, they simply deflate the balloon if you’re unable to handle it.
The angiogram will allow us to see if the remnant has grown in a year and we’ll have the balloon test done and that will determine, should I NEED to treat the remnant, that blocking the artery and reversing the blood flow is a good option. If I’m unable to handle the test, then that’s another option off the table.
There is another potential, more invasive option, but I’m not even going to go there yet. We’ll wait a year, see if the remnant has gotten any bigger, and DOES need treatment, before we address it further.
So, I’ll continue to eat better, try to get more exercise, and reduce stress……the last one will be the hardest I think. Kick the can….
Heidi's Brain Blog 