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School of Medicine
Physician Update - A Possible Aneuysm Cure
Physician Update Winter 2014
A Possible Aneuysm Cure
Date: January 1, 2014
Alex Coon and Geoffrey Colby are performing a new type of surgery that offers an opportunity to remove aneurysms completely.
While surgeons used to treat brain aneurysms with lengthy operations that required removing large portions of the skull, says neurosurgeon Alex Coon, they now are often treated through coiling—threading a long, thin platinum wire from an artery in the groin all the way up to the aneurysm in the brain and packing it into the weakened pouch in the blood vessel. If all goes well, the coiled platinum induces a clotting response, which closes off the aneurysm.
Coiling is superior to open surgery in terms of duration of the procedure, not needing to open the skull, and recovery times,” Coon says. “But the downside is that there’s a high recurrence rate.”
In about 10 to 30 percent of cases, he says, the clot dissolves and the aneurysm reappears. The risk is even greater for very large aneurysms, which have recurrence rates up to 50 percent.
However, a new procedure offered at Johns Hopkins could prevent recurrence for all sizes of aneurysms. It involves placing a very flexible, thick mesh stent in the blood vessel.
These stents, which resemble miniature Slinky toys, prop open the blood vessel and divert flow from the pouch. Over time, Coon explains, reduced flow to the aneurysm causes it to clot and eventually close on its own.
Although the procedure can take weeks or months to work, far longer than the nearly instant results from coiling, the stent offers the possibility of permanently removing the aneurysm. “This device offers a cure, with no recurrence,” Coon says.
Over the short time that this stent, known as the Pipeline Embolization Device, has been offered in the United States, Johns Hopkins has been one of the leaders in performing this surgery, Coon says. He and his colleagues have placed more than 150 of the stents in patients and traveled around the country teaching the technique to other physicians. This extensive experience is drawing patients to Johns Hopkins from across the United States.
To handle increasing demand, Coon was recently joined by a new colleague, Geoffrey Colby, who trained at Johns Hopkins for his neurosurgery residency as well as a fellowship in techniques that allow problems in the brain to be treated through instruments fed through blood vessels elsewhere in the body.
“Having a larger team,” Coon says, “will make this therapy even more accessible for our patients.”