PLANO, Texas — A new, minimally invasive technology at Texas Health Presbyterian Hospital Plano is helping treat brain aneurysms — the dangerous swelling of blood vessels in the brain — that can cause debilitating pain, permanent neurological damage and at times, can quickly become fatal. Last month, Texas Health Plano became the first hospital in Collin County to offer a unique procedure that could effectively addresses aneurysms in less time and with fewer medications than traditional procedures.

James Tatum, M.D.

A brain aneurysm causes the blood vessel to bulge or balloon in size as it fills with blood and sometimes looks like a cherry hanging on a stem. The more blood that fills the brain’s weak blood vessel, or aneurysm, the higher the possibility of the aneurysm rupturing. The Woven EndoBridge aneurysm embolization, or WEB, is a single-device procedure designed to interrupt blood flow entering the brain aneurysm to help promote clotting and avoid ruptures. Using an X-ray camera, doctors guide a thin tube, or catheter, into the patient’s leg artery, passing through the body’s main artery — the aorta — and then to an artery supplying blood to the brain. Placing a smaller catheter inside the first one, the WEB device is inserted into the aneurysm.

“This new technology is possibly eliminating the need for a stent implant, shortening the procedure time, decreasing radiation exposure and conceivably reducing the amount of medication required after the procedure,” said James Tatum, M.D. He and Thomas Madaelil, M.D., both interventional neuroradiologists on the Texas Health Plano medical staff, performed the first procedures in Collin County.

Patient Janice Ledford said she was skeptical before the procedure.

“The device was weird-looking when Dr. Tatum showed it to me,” Ledford said. “It was about the size of a capsule, and it flowered out like a spider web in my hand.”

The retired elementary school employee was one of Texas Health Plano’s first neurosurgical patients to undergo the WEB procedure. Her four-millimeter aneurysm affected several vessels in her brain and had been causing debilitating headaches for years.

“At times, I would scream from the pain, it was so terrible,” she said. “I would go to bed in agony and cry some nights. But this procedure put an end to all of that nonsense.”

At first Ledford was unsure of trying the new approach. “I just put my trust in God and Dr. Tatum, and now I’ll have this device in my brain for the rest of my life.”

There are several ways to address complex aneurysms, but the shape, size and location of the aneurysm determines the best procedural approach, Madaelil said.

And Tatum added that the larger the aneurysm, the more challenging the treatment.

Large, wide-necked aneurysms can be difficult to treat with coiling, stenting or even with surgical treatment. Tatum said surgical clipping requires opening the skull. And to stop blood flow to the aneurysm, a tiny, clothes-pin-like device is used. Endovascular surgery, or treatment through the blood vessels, can require multiple procedures or the use of additional devices, such as stents, to keep the vessel working properly

“Unfortunately, those procedures can increase the risk of stroke and other complications,” he said.

With endovascular coiling, a micro-catheter and the attached coil are inserted through a patient’s leg artery and guided to the aneurysm in the brain. An electrical current is used to deploy the coil, seal the opening of the aneurysm and stop it from rupturing. The soft metal coils, shaped like tiny springs, can be twice the width of a human hair or smaller. But the larger the aneurysm, the more coils needed to seal it. Additionally, stents are sometimes used to keep the coils in place.

Another form of endovascular surgery, the WEB procedure involves a micro-catheter and a tiny, basket-like, wire-meshed device, about the size of a pill.  After guiding the WEB device into the brain, doctors place the device directly into the aneurysm to stop blood flow and force clotting of the aneurysm, eliminating the need for coils and stents.

“Stents require blood thinners, but the WEB helps diminish the need for blood thinners and the risk of stroke associated with stents,” said Tatum. “Getting rid of stents and medication can be a win-win, especially for the patient.”

It’s the early days of this technology, added Madaelil. “But the WEB device has the potential to replace coils, coil-assist devices and even surgical clipping.”

The WEB technology also saved retired U.S. Army contractor Carl Smith. A few weeks before his procedure, the 64-year-old suffered a mild stroke. He was admitted to Texas Health Plano where a CT-scan showed a 10-millimeter aneurysm in his brain.

"Mr. Smith’s aneurysm would have required the coiling method with stents, along with blood thinners, but by using the WEB device, we avoided both,” said Madaelil.

Neither Ledford nor Smith required clinical rehabilitation, and both went home less than two days after the procedure. Ledford found immediate relief from the headaches.

When brain aneurysms continue to grow and aren’t addressed through endovascular or open surgical treatment, close to 30,000 people in the U.S. end up with a ruptured brain aneurysm each year, according to the National Institute of Neurological Disorders and Stroke.

“Thankfully, that wasn’t the outcome for Ms. Ledford and Mr. Smith,” Tatum said. That and more was accomplished; but most importantly, they are enjoying life with family and friends, minus the anxiety and risk of death or disability from a bleeding aneurysm.”

Follow this link for more information about Texas Health Plano’s customized patient care for neuroscience services.