At least two percent of the population harbors aneurysms — fragile, bubble-like bulges that can occur at weakened areas in the arteries supplying blood flow to the brain. These aneurysms can burst, causing life-threatening brain bleeding. A significant percentage of these are wide-necked bifurcation aneurysms (WNBAs), a common type of brain aneurysm that arises at blood vessel branch points. All aneurysms that rupture require neurosurgical treatment, as do many that don’t rupture.
David Fiorella, professor of neurosurgery and radiology in the Renaissance School of Medicine and director of Stony Brook Medicine’s Cerebrovascular and Stroke Center, is treating brain aneurysms and conducting clinical research using novel devices for safer, minimally invasive endovascular treatment of complex aneurysms. One such device is the Cerus Contour Neurovascular System™, groundbreaking technology designed specifically to treat WNBAs.
“WNBAs are fairly common,” said Fiorella, estimating that they account for about 25 percent of treated aneurysms. “They are also among the most challenging to treat.”
The danger posed by aneurysms is that the affected vessel fills with blood, causing it to increase in size. Bifurcated aneurysms bring additional risk because of the way they are situated in the byways of the brain’s vasculature.
“A bifurcation is like when a road branches off into two roads, or in this case, when a vessel branches into two or more branch vessels,” said Fiorella.
This type of aneurysm is so complex and develops with such uncertainty that treatment is difficult, and sometimes even impossible, with currently available methods. Typically, patients would be treated with other devices and open surgery.
“A lot of patients who might have required open brain surgery or other complex procedures can be more easily treated with this device,” said Fiorella. “And likely more safely.”
The Contour is infinitesimally small, and is permanently put in place using a minimally invasive technique. A clinical trial is currently underway in the United States. Stony Brook is one of six U.S. centers currently participating in the trial.
Late last year, Fiorella operated on an asymptomatic patient whose brain aneurysm was discovered after her cardiologist ordered a CTA scan as part of an evaluation. She was referred to Fiorella, whose assessment made her eligible for the Contour trial. Her procedure was the first completed with this device on Long Island and at Stony Brook, and only the 12th in all of North America.
Fiorella said that while the Contour is still in clinical trial, it could prove to be the standard of care for WNBAs in the future. However, he cautions that there is still a long road ahead, estimating that it will probably take at least one or two years for the trial to be completed.
“This can potentially change the way we operate on these aneurysms,” said Fiorella. “It is our hope that it makes the treatment easier, safer and more durable.”
Timothy Falvey is an example of the type of patient this technology might benefit.
Falvey had experienced headaches for several weeks approaching the holidays in 2021. Normally healthy, he was alarmed enough to go to the emergency room when the headaches did not subside. An examination found that Falvey had a brain hemorrhage due to a ruptured wide-necked aneurysm and he was rushed into surgery, where the Contour device was used to repair the aneurysm.
The procedure was likely lifesaving. A month later, Falvey was feeling good and preparing to return to his job.
“He probably would have had to have open brain surgery,” said Fiorella. “We know from trials that patients with ruptured aneurysms have a lower risk of disability and poor outcomes with minimally invasive treatment than with surgery. We were very fortunate to have this option available.”
Though he said researchers won’t know the true capabilities of Contour until the U.S. trial is completed, the results from a European study conducted are encouraging. To date, Fiorella has completed the most aneurysm cases with the Contour device in the nation.
“Many patients with brain aneurysms are presented with few options for treatment,” said Fiorella. “That’s why it’s critical to seek out the doctors and institutions that have access to the most contemporary technologies. In many cases these technologies can be the difference between major open brain surgery or a minimally invasive technique. We know from a long history of experience that minimally invasive techniques are associated with much better recovery periods and in many cases are much safer. You only have one brain. It’s worth getting a second opinion.”
— Robert Emproto