The National Institute for Healthcare and Clinical Excellence (NICE) have today announced support for an innovative medical device, known as a pipeline embolisation device, which can treat patients with complex brain aneurysms.
An aneurysm is a bulge in a blood vessel caused by a weakness in the blood vessel wall. If an aneurysm ruptures in the brain this will lead to a haemorrhage and can cause death or serious brain damage. Symptoms of an aneurysm include sudden severe headaches, stiff neck and nausea.
Consultant Neurosurgeon, Mr Ian Sabin, had the following comments about the new treatment:
Flow diverting or pipeline stents have been in use for a few years, with preliminary reports of efficacy appearing in 2007. They have significantly improved the management of difficult aneurysms that were not possible to treat, either by standard coiling methods or by direct surgery. Their use is mainly for large, broad-necked aneurysms or for so-called 'fusiform' expansions of the artery. By 'reforming' the vessel with the stent, it is also possible to preserve the very fine 'perforating' arteries arising directly from it, which normally supply very sensitive areas of the brain. Before treatment, the patient needs to take anti-platelet drugs to reduce the risk of blood clotting within the stent and blocking it. Normally a combination of Clopidogrel and Aspirin is used for anything up to five days before the procedure. This limits the use of pipeline stents in recently ruptured aneurysms due to the risk of re-bleeding.
These stents work by reducing the flow of blood into the aneurysm (hence flow diverting) allowing the blood present within the aneurysm sac to clot and seal it off from the circulation. They do not always achieve this however and the failure rate may be as high as 30%, but this will improve as the technology develops. There are potential complications which include stent thrombosis, stroke and aneurysm rupture but for the type of aneurysms being treated (giant or complex intracranial aneurysms), stents represent the most effective and lowest risk treatment available today.