Those that are small and do not cause symptoms may not need treatment but will likely need to be followed by a doctor in the event that they begin growing. If you have a large or leaking aneurysm, you may need to undergo treatment to help prevent them from expanding and weakening an artery wall (causing an aortic dissection or rupture), or to prevent or reverse damage to other areas of your body. (1) It’s important to know that an aneurysm that has ruptured is an emergency and requires surgery. Here’s a closer look at the treatment options for an aneurysm that your doctor may present to you. The size of the aneurysm and how fast it grows are two factors that will determine how frequently you may need testing. The larger and faster the aneurysm grows, the more often your doctor should check it. (1) Compared with large aneurysms, small aneurysms have a lower risk of rupturing, but that doesn’t mean they’re harmless, says George P. Teitelbaum, MD, an interventional neuroradiologist at the Pacific Neuroscience Institute in Santa Monica, California. For brain aneurysms that have not ruptured, doctors will typically compare the risks of rupture to the risks of treatment before deciding on a treatment plan. (3) Doctors will also consider the type, size, and location of the brain aneurysm, along with the person’s age, health, and personal and family medical history. (4) Following are some options you may explore with your doctor:
Surgery
If an aneurysm is growing or at risk of rupture or dissection, your doctor will likely perform surgery. Brain aneurysms that have burst will require emergency surgery for the aneurysm itself and to evacuate blood from the skull, or to drain excess fluid from the brain. There are two options for a ruptured brain aneurysm: endovascular embolization (aka endovascular aneurysm repair, or EVAR) and microvascular clipping. The type of surgery your doctor chooses is largely dependent on the size and location of the aneurysm. It can also depend on the following factors: (3)
The patient’s ageThe shape of the aneurysmThe patient’s neurological conditionThe patient’s other medical conditionsThe patient’s personal history of subarachnoid hemorrhage (SAH)The patient’s family history of aneurysm
Know that both types of surgery carry risks, such as damage to other blood vessels, recurrence and rebleeding of the aneurysm, and stroke after the surgery. (4)
Microvascular Clipping
Microvascular clipping is a treatment that cuts off blood flow to an aneurysm in the brain. Once the patient is under general anesthesia, surgeons remove a section of the skull and locate the aneurysm. Using a microscope to locate the blood vessel that feeds the aneurysm, the surgeon places a small titanium clip across the neck of the aneurysm to stop the blood flow. The clip stays in permanently to prevent bleeding and recurrence of the aneurysm. The section of skull is then replaced and the scalp is closed. (4,5) Because it’s an invasive surgery, microvascular clipping recovery time may span between three and six weeks. (6) An occlusion is another, similar procedure in which the entire artery that leads to the aneurysm is clamped off and is usually performed when there is damage to the artery. An occlusion can also include a bypass procedure, in which a small blood vessel is attached to the brain artery, diverting blood from the section of the damaged artery. (4) Once the catheter is at the site of the aneurysm, spirals of platinum wires called coils are passed through the catheter and inserted into the brain aneurysm. The coils fill the aneurysm, stabilize it, and prevent blood flow into it. The wires cause the blood to clot, which obliterates the aneurysm. (4,5) Because endovascular coiling takes less time than clipping, the recovery period is also shorter — about one to two days if there is no bleeding. (7) The downside to endovascular embolization is there is a higher risk of recurrence compared with microvascular clipping, so regular monitoring with an angiogram may be necessary.
Flow Diversion Treatment
If a patient’s brain aneurysm is large or wide, doctors may opt for flow diversion treatment. Flow diverters are devices made of fine metal wires that guide blood flow through the artery and past the aneurysm, resulting in closure of the aneurysm. “It is a remarkable device because it allows flow to the important, normal branches, but it deprives the aneurysm of the flow that is necessary to cause it to enlarge,” Dr. Teitelbaum says. “Over time, the aneurysm is likely to shrink and disappear,” he says. There’s no risk for recurrence or rebleeding of the aneurysm after flow diversion, so this is the only treatment patients may consider a cure for aneurysms, Teitelbaum says. Some blood pressure medicines, especially calcium channel blockers and beta blockers, can help relax artery walls and cut down on the risk of a rupture. (1) To prevent vasospasm, a condition in which the arteries in the brain narrow after a rupture, your doctor may prescribe certain drugs, such as nimodipine and atorvastatin (Lipitor), because research suggests this course of action may be beneficial. A study published in the journal Critical Care Medicine found that atorvastatin used by patients who suffered a subarachnoid hemorrhage (SAH) helped reduce the incidence and severity of vasospasm. (8) Another study published in the Journal of Korean Neurosurgical Society found a high dose of simvastatin (Zocor) was also effective in preventing vasospasm. (9)
Surgery
The two main operations to repair a large, leaking, or ruptured aortic aneurysm include open-chest, or abdominal repair and endovascular stenting. Open Repair Once the patient is put under general anesthesia, the surgeon makes a large incision in the chest or abdomen. The aneurysm and a portion of the aorta are removed, and the section of the aorta is replaced with a graft made from a synthetic material, such as Dacron or Teflon. The surgery takes between three and six hours, and requires five to eight days of recovery at the hospital. Usually, patients make a full recovery in one month. If the aortic heart valve needs to be repaired, doctors perform it during open-chest or open-abdominal surgery. (1) Endovascular Stenting Unlike open repair, endovascular stenting doesn’t remove the aneurysm. After administering general anesthesia, the surgeon threads a catheter into the artery through the groin and into the location of the aneurysm. Using an X-ray to visualize the artery, the surgeon inserts the collapsed stent or graft into the aorta to the aneurysm. The stent is expanded to fit snugly within the aorta. Blood then flows through this stent and no longer enters the aneurysm. The stent also reinforces the weakened section of the aorta, which helps prevent rupturing. If the aneurysm is uncomplicated, the recovery time for endovascular stenting is much shorter than it is for surgery: one to three days versus 7 to 10 days, Teitelbaum says. For repair of abdominal aortic aneurysms, the type of surgery depends on the anatomy of the aneurysm and its location, and specifically whether the aneurysm comes close to the renal, or kidney arteries, Teitelbaum says. In that case, doctors may have to use more complicated devices that have branches built into them. “This technology is evolving, and as time goes on, more and more of these difficult aneurysms will probably be done by endovascular means as well,” Teitelbaum says. Ruptured abdominal aortic aneurysms require emergency surgery. Both open repair and endovascular stenting are options. In general, endovascular stenting is a better option for patients who are considered high-risk for open repair, but without enough research available, the patient’s preference is the deciding factor. (11) Because high blood pressure is considered a risk factor for aneurysms, it’s also crucial to make diet and lifestyle changes to manage blood pressure and stress, and get plenty of sleep. Also, if you have obstructive sleep apnea (OSA), be sure to get proper treatment for the condition, as it may increase your risk of high blood pressure and obesity, among other health problems linked with aneurysms. (12)
