endovascular surgery to treat aneurysms

Written by: Dr.Prof. Alfredo Casasco
Published: | Updated: 14/11/2018
Edited by: Anna Raventós Rodríguez


How was the usual treatment of aneurysms in the past?

Until a few years ago the aneurysm was surgically. Today, in certain aneurysms surgery it remains valid; however, treatment is directed to less invasive techniques to not open the skull and access the aneurysm by endovascular surgery.


What is the purpose of intervening on aneurysms?

It is intended to fill the aneurysm and isolate. Endovascular treatment was started in the 90s when a system very flexible platinum coils that are placed within the aneurysm was devised. Eventually, blood flow compacted coils and the aneurysm neck is reopened, which had the potential rebleeding result thereof.

brain aneurysm


How it has evolved in the intervention of aneurysms?

Gradually techniques were allowing further fill the aneurysm. These techniques utilized a inflated balloon against the aneurysm, which could increase the density of turns in the aneurysmal neck. The possibilities of reopening were lower, but still observed.


What solution has been sought?

It was thought necessary to change the direction of flow. To vary it, the only option was the stents, such as those placed in the coronary arteries, which allow the flow, instead of going into the aneurysm, continue through the artery.


How are these Stent?

These new prostheses have a dense mesh that allows a slowing of blood flow into the aneurysm. At the same time, Stent must allow blood to flow to areas where there is an effect of call, as in the arteries that can be found around the aneurysm. It is the revolution of the new Stent.


Are there varieties of Stent?

There are two types of stent; some are dense mesh and others are covered by multiple membrane. The two keep arteries open but covering the aneurysm.


Drawbacks of Stent

The Stent is a foreign body that the body tends to reject and create clots. For that not to happen it is necessary to medicate the patient with antiplatelet agents, two for a few months (clopidogrel and aspirin) and one (aspirin) onwards. This limits the number of people who can make this intervention which is contraindicated in patients with gastric ulcer, digestive problems or bleeding.


What kind of aneurysms are indicated Stent?

aneurisma_aorta Stents are indicated especially in giant aneurysms or the scoop neck, which if not treated with this technique very frequently revascularized after treatment. And in small aneurysms with a small neck you can be used the traditional technique (platinum coils), which remains valid. The coils have proven to be far superior technique to open surgery. Moreover, the quality of life of patients treated by endovascular surgery was superior to that of those treated surgically.


Is the treatment of giant aneurysms can be carried out in all schools?

Today tends resolve aneurysms by endovascular surgery, but there is enough trained crews to operate any type of aneurysm. In Spain, most hospitals can meet the standard aneurysm, but to treat aneurysms of high complexity, the number of teams is less prepared. You need to master all the techniques in the treatment of aneurysms: traditional, the use of balls, the Stent or combine several. In addition, you must have access to an important infrastructure: Intensive Care Unit, Department of Neurology, Neurosurgery and Radiology that allows access to high-definition resonance and computerized tomography.


What should treat aneurysms?

The trend is to have under control (but not intervene) aneurysms less than five millimeters, asymptomatic and have little chance of bleeding. When they exceed that size are more likely bleeding. Then it is advisable to indicate treatment.


Treatment of aneurysms

It is preferable that the treatment is surgical endovascular instead of. The risk of bleeding is cumulative over the years. Although the risk increases only 2.5% each year, it is noteworthy that the figure after a decade reaches 25%. Half of the patients arrive at the hospital when their aneurysm begins to bleed. Of those who arrive, only half left in good condition. The rest is a serious deficit or need assistance just to continue normal development in his life.


For more information consult a specialist Neuroradiology .


*Translated with Google translator. We apologize for any imperfection

By Dr.Prof. Alfredo Casasco

Dr. Casasco is a pioneer in the endovascular treatment of cerebral aneurysms and brain, maxillofacial and spinal vascular malformations. He has made the development of treatment techniques combined with percutaneous puncture maxillofacial surgery vascular malformations. The doctor is recognized internationally as one of the leading specialists in the treatment of spinal cord and brain malformation adult and child vascular pathology.

In 1992, he developed techniques of pial microcateterismo retrograde veins in the treatment of cerebral vascular malformations as well as treatments maxillofacial devascularization and intracerebral tumors by direct puncture percutaneously.

It has developed and published treatment techniques of spinal arteriovenous fistulas by direct puncture and retrograde catheterization.

*Translated with Google translator. We apologize for any imperfection

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