Treatment Options
Stroke ...
For many stroke victims, prompt treatment and follow-up care may protect these brain cells and help them lead healthier, more productive lives. To minimize the damage of a stroke, victims must seek treatment immediately. It is vital that treatment be administered within six (6) hours from the onset of a stroke. It is a challenge for medical personnel to treat the patient as quickly as possible to avoid permanent tissue damage or death, while racing against the clock to re-establish blood flow to the brain.
Immediate treatment after the onset of a stroke can result in little visible damage, but a stroke left untreated for too long can result in neurological and tissue damage (such as paralysis or permanent loss of speech) or paralysis) or death.
Brain Aneurism ...
When an aneurysm is discovered (ruptured or unruptured) it must be evaluated to see which treatment option is best. Currently, there are two types of aneurysm treatment options - clipping and coiling.
1. Clipping of aneurysms are performed by neurosurgeons. This procedure is performed by an open approach involving a skin incision, craniotomy (opening of the skull), retraction of the brain (to reach the aneurysm), and clipping of the aneurysm (placing a small “clothespin-like” clip across the aneurysm neck).
2. Coiling of aneurysms is performed by an interventional neuroradiologist. The field is known as Neuroendovascular Surgery, Interventional Neuroradiology, or Endovascular Neurosurgery (Endovascular Neuro for short). This procedure is performed by entering the circulatory system through a needle sized hole in an artery in the leg and using x-rays to guide catheters (small plastic tubes) into the brain. Once there, an even smaller tube called a microcatheter is guided into the aneurysm. Small platinum coils are then carefully placed within the aneurysm to close it. The catheters are then removed, and a small Band-Aid is placed on the leg at the catheter entrance site.
A recent international study called ISAT (The International Subarachnoid Aneurysm Trial) was conducted which compared clipping to coiling. The landmark clinical trial was to enroll 3,000 patients, but was halted after 2,134 patients because coiling showed a clear advantage over open neurosurgical clipping. Patients who had ruptured aneurysms were placed into one of two groups: neurosurgical clipping or endovascular coiling.
The results showed that on one-year follow-up:
· 30.6% were dead or dependent (having severe disability) in the neurosurgical group,
· 23.7% were dead or dependent (having severe disability) in the endovascular group.
This represents a 22.6% relative risk reduction and a 6.9% absolute risk reduction by undergoing the endovascular coiling procedure.
The overall mortality rates were similar in both groups:
· 10.1% of the people died in the neurosurgical group.
· 8.1% of the people died in the endovascular group.
This means that for every 100 patients treated, around 7 could expect to be better off in one year if they received endovascular treatment as opposed to neurosurgical treatment. The study also looked at the re-bleeding rate of the aneurysms up to seven years and found 0.16% (less than 1 percent) re-bleed rate for the endovascular group, and 0% re-bleed rate for the neurosurgical group.
The ISAT study concludes that “In patients with a ruptured intracranial aneurysm, for which endovascular coiling and neurosurgical clipping are therapeutic options, the outcome in terms of survival free of disability at 1 year is significantly better with endovascular coiling”. This does not mean that all aneurysms should be coiled. There are certain types of aneurysms that are much better treated by a neurosurgical approach, and aneurysms that are much better treated by an endovascular approach.
Physicians agree that if you have an unruptured aneurysm, you should be evaluated at a medical center that has both neurosurgical and endovascular physicians. Every aneurysm and every patient is unique, and the pros and cons of each procedure should be weighed by the patient before a decision is made.
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