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A brain aneurysm is an abnormal bulging outward of the wall
of an artery. The defect is most common among people between
the ages of 35 and 60. Brain aneurysms can cause a stroke
when they rupture and blood flows into the brain or the
space closely surrounding the brain.
The traditional treatment for a ruptured brain aneurysm
was surgery. Neurosurgeons placed metal clips across the
neck of the aneurysm in an effort to stop arterial blood
from escaping into the brain.
In contrast to surgery, a less-invasive approach uses a
technique called endovascular treatment. Interventional
neuroradiologists insert a small plastic tube called a catheter
through an incision in the patient's leg into the femoral
artery, and through the use of X-ray guidance, navigate
the catheter through the vascular system into the brain
and inside the aneurysm. Next, the interventional neuroradiologist
threads tiny platinum coils through the catheter into the
aneurysm, obstructing the blood flow into the aneurysm.
Researchers say that the ISAT results indicate that treating
ruptured brain aneurysms with coils - called embolization
- results in better outcomes for patients when compared
to the surgical placement of clips. John C. Chaloupka, M.D.,
professor and director of the Interventional Neuroradiology
Service at the University of Iowa Hospitals and Clinics,
is an internationally recognized expert in the endovascular
treatment of brain aneurysms. He has served in various advisory
and scientific capacities for several endovascular clinical
trials, including a recently proposed international clinical
trial comparing outcomes of clipping versus coiling of unruptured
aneurysms called ISUIA (International Study of Unruptured
Intracranial Aneurysms). "The ISAT Study results provide
a very important, albeit preliminary step in changing the
basic management paradigms of intracranial aneurysms, which
will eventually transition endovascular techniques into
a first line or primary treatment modality " said Chaloupka.
Investigators ended the study early when a planned analysis
of the early results showed that the data about the endovascular
technique's superiority were so convincing that to have
continued enrolling patients would have been considered
unethical.
Dr. Chaloupka is one of the first physicians in the world
to perform this endovascular technique of deploying micro-coils
in brain aneurysms, which was developed at the UCLA Medical
Center between 1990-91. For over a decade he has performed
several hundred of these micro-coil embolization procedures.
Currently, University of Iowa Health Care specialists led
by Dr. Chaloupka perform micro-coil embolization in 100-120
brain aneurysms per year, making UIHC one of the busiest
centers in the nation. Seon Kyu Lee, M.D., assistant professor
of Radiology at UIHC, participated in ISAT while at the
University of Toronto. "Although we will need to see the
long term outcome analysis of ISAT, the early outcome results
of this study will now provide a nice opportunity for neurosurgeons
and neurointerventional radiologists to discuss the evolving
management strategies for ruptured intracranial aneurysms"
said Lee.
A stroke occurs every 53 seconds in the U.S, affecting
nearly 600,000 Americans. One third of them will die as
a result, making stroke the nation's third leading cause
of death, as well as the leading cause of severe, long-term
disability. Bleeding into the brain causes about two out
every ten strokes. The other eight out of ten involve blockages
in arteries that supply blood to the brain.
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