Dec. 22, 2023
Decisions about whether to treat intracranial aneurysms are complex, requiring careful weighing of potential benefits and risks to individual patients. Mayo Clinic uses the latest aneurysm devices to avoid complications and facilitate endovascular aneurysm repair.
"Advanced devices are chipping away at the risk of treating aneurysms," says Bernard R. Bendok, M.D., chair of Neurosurgery at Mayo Clinic in Phoenix/Scottsdale, Arizona. "The equation is increasingly shifting in the patient's favor, with the surgical team able to offer more less invasive options."
The innovations include:
- Stents with anti-thrombotic coatings, which help reduce the risk of occlusion in parent arteries.
- Intrasaccular flow disruption devices, which help overcome the challenges of achieving occlusion in wide-necked bifurcation aneurysms.
"Mayo Clinic always adopts and helps innovate safer, less invasive and more effective techniques," Dr. Bendok says. "That's in line with our value that the patient's interests come first."
Reducing risks
Flow-diverting stents can trigger thrombosis, due to their relatively high metal coverage of vessel walls compared with conventional stents. Thrombosis can lead to stent occlusion, eventually causing ischemic stroke.
Anti-thrombotic coatings help overcome that challenge. "The surface modifications reduce thrombogenicity and can make it safer to treat aneurysms," Dr. Bendok says.
Traditional flow-diverting stents require dual anti-platelet therapy, to avoid thrombosis. Concern about the use of blood thinners has limited the use of flow diverters for treating ruptured aneurysms. But anti-thrombotic coatings reduce the need for anti-platelet therapy.
"Mayo Clinic is moving towards using anti-thrombotic flow diverters in selected cases of ruptured aneurysm that cannot be treated otherwise," Dr. Bendok says.
Although efficacious for repairing side wall aneurysms, stents are less useful for managing wide-necked bifurcation aneurysms. Intrasaccular flow disruption devices can achieve durable occlusion while preserving major parent vessels.
"If you can't use a stent or coil — due to the aneurysm's wide neck — the only solution has been surgery," Dr. Bendok says. "That's not necessarily a bad solution. But closing the aneurysm with an intrasaccular device is a less invasive option." Treatment with an intrasaccular device also limits the need for blood thinners.
"Mayo Clinic has embraced these new treatments because of our desire to improve outcomes," Dr. Bendok says. "We are committed to integrating these technologies thoughtfully into our practices, so patients benefit."
For more information
Refer a patient to Mayo Clinic.