CDH physician hopes to pinpoint cause of ruptured brain aneurysms
According to some doctors, only about 20 to 25 percent of people with brain aneurysms have actually been diagnosed. But if one ruptures and bleeds in the cranium, it quickly changes life for people and their family as they know it.
A doctor at Central DuPage Hospital is hoping to pinpoint the causes of ruptures in an effort to treat those most likely to do so earlier and save lives in the process.
Up until now, conventional wisdom has said that the larger an aneurysm, the more likely it will rupture.
But Dr. Rajeev Deveshwar, an interventional neuroradiologist at CDH, says that does not explain what causes the ruptures, especially considering that aneurysms of all sizes can and do rupture.
“The real thrust of the study is to identify the markers which people exhibit and use that to determine which aneurysms are stable and which are unstable,” he said.
An aneurysm occurs when the walls of a blood vessel in the brain weaken over time, resulting in a ballooning or bulging of a section of the vessel. About 10 percent of aneurysms rupture, Deveshwar said, and the likelihood of survival depends upon quick treatment.
“We see a lot of patients who come in with small aneurysms that burst, so there must be something other than the size that causes the ruptures,” he said.
Thus far, Deveshwar has included between 10 and 15 patients in the study. The data required for the study has been compiled through regular treatment of patients with aneurysms.
As more data is compiled, Deveshwar hopes to see a pattern of characteristics that contribute to ruptures. This would give doctors a reason to recommend treatment sooner.
“We have to justify treating these patients,” he said. “This will decrease the death rate and mortality from such a condition.”
According to Deveshwar, 15 percent of patients whose aneurysm ruptures and bleeds into the area between the brain and the thin tissue that covers the brain, a subarachnoid hemorrhage, die instantly. Another 15 percent will die within 48 hours regardless of medical treatment. Just 15 to 20 percent return to a normal lifestyle with the remainder needing help with daily living.
“In the end we all have to share in the burden of looking after these patients,” he said.
Right now, two common treatments pose their own risks. In one, surgeons insert a wire through the groin and guide it toward the aneurysm. Once there, the wire coils up and seals the aneurysm from the artery. In a second, a portion of the skull is removed and surgeons use a metal clip to block blood flow to the aneurysm.
In the coiling treatment, if the neck of the aneurysm — the point at which the artery bulges — is too narrow, a stent must be inserted.
Deveshwar said he hopes to use the study as a springboard to develop the means to virtually treat aneurysms using microprocessors, high-speed computers and data compiled from standard tests. The program could determine early whether treatment would require a stent and whether the aneurysm is at risk for rupture.
“We can then devise a treatment and figure out a treatment plan before we even start treating the patient,” he said.
“People with aneurysms, they can be serious and they can cause dire straits if they rupture,” he said. “If we can identify it early, we can tell the patient how to treat it before it becomes nasty.”
Deveshwar said the main thing he wants to do for now is raise awareness among doctors and patients about aneurysms so that ruptures are less frequent and lives are saved. Most aneurysms are diagnosed when doctors order a CT scan or MRI looking for something else.
“There are more people waiting around with aneurysms than we know,” he said. “Once it ruptures, the story is over.”