Neurosurgeons in New Jersey are making increasing use of a new, minimally invasive device called the Pipeline to treat large brain aneurysms when surgery is too risky.
Manufactured by medical device maker Covidien, the Pipeline was approved by the Food and Drug Administration last year for patients with large brain aneurysms in difficult areas, such as near the eyes. It is recommended for cases in which surgery poses too grave a high risk of impaired neurological function, or standard minimally invasive procedures aren’t effective.
Some surgeons predict that as the medical community gains more experience with the device, and as the technology improves, a wider population of patients suffering from brain aneurysms should become Pipeline candidates.
The Pipeline is a stent that is inserted via a catheter into an artery at the groin, threaded through the body up to the brain, and then placed into the blood vessel. The aneurysm, which is a bubble or balloon that has formed on the surface of the blood vessel, is bypassed by the stent, enabling blood to flow normally, shrinking the aneurysm, and reducing pressure on the brain.
Minimally invasive procedures that reach brain aneurysms via a patient’s veins have been around for at least 15 years, but the Pipeline is a new development.
"For the patients that it can treat, it will be potentially revolutionary,” said Dr. Chirag D. Gandhi, director of the endovascular neurosurgery fellowship at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School. “It’s an entirely new approach: The stent diverts blood from going inside the aneurysm and causes the aneurysm to close off by itself.”
Dr. Erol Veznedaroglu, chairman of the neurosurgery department at Capital Health in Hopewell, has done several Pipeline procedures, including one for a ruptured brain aneurysm. He said the new stent “is for very sick patients who really won’t tolerate open surgery” or for whom older noninvasive therapies are not adequate.
“It is for a very small niche of patients that have very large aneurysms, generally behind the eye, that are causing pressure. The stent kind of deflates the balloon [the aneurysm] so to speak.” He said the device is indicated for what are sometimes called “giant” aneurysms that can be as large as 2.5 centimeters.
Dr. Ciro Randazzo of the AtlantiCare Neurosciences Institute said the stent is working well for patients with large brain aneurysms and limited options. If these patients had open brain surgery “often with these giant aneurysms there was a 25 to 50 percent risk of a serious neurological complication with surgery” while the complication risk is about 10 percent with Pipeline.
Randazzo said he has been trained to teach the procedure and will travel to other hospitals around the country to train neurosurgeons.
“This is a first step forward in technology that will ultimately spur us on to develop similar sorts of technology that may broaden the indications for its use,” said Dr. Paul Saphier of Englewood Hospital and Medical Center. Gandhi of UMDNJ said medical technology “keeps getting better, and some remarkable engineering has gone into this. Even five years ago, the development of a stent like this would have been difficult to conceptualize.”