Six Month Follow Up: ALL CLEAR!!
I had my 6 month follow up angiogram yesterday 4/13/2023. My neurosurgeon was extremely pleased and so am I.
This was the lightest anesthesia I had in all of the three of my procedures. My neurosurgeon was able to talk to me on the table, I was less “drunk.” They said they pushed the dye in the same way as the first time, but it felt to me like they did not go all the way up into my neck. (I believe them must have gone up to my neck, I just didn’t feel it.). I could definitely feel when they dye went it, more so than the first time. It doesn’t hurt, if felt more like my entire head being flooded with very warm water. Just for a few seconds.
So before I was off the operating table, my neurosurgeon and the rest of his team were able to talk to me, and said I was all clear. I.e., that it looked very good, and no more Brillinta!
In a prior teleconference with my neurosurgeon he had said there were three possible outcomes after six months:
- The angiogram would show that blood was flowing through the flow diverter into the rest of my brain.
- The angiogram would show that the artery had completely blocked up. (My surgeon said this would still be a “good” outcome because it would mean that the artery was blocked and yet I hadn’t had any real negative effects during the past six months. Whatever was going to happen had already happened. That this would be considered a “good” outcome was a bit surprising to me.
- The angiogram would show that the the artery was partially blocked. This is the worst outcome because it would mean I would have to stay on Brillinta for another six months. I have been 70% sure that the Brillinta was tiring me out and giving me other negative symptoms (see above post on 4/12).
But before I was off the operating table my surgeon said "It’s option #1! **All clear! **
It is a HUGE relief to know both that its not blocked or partially blocked and that I can stop the major blood thinner. Huge load off my mind.
I did not get as good a picture of my artery post-flow diverter, but I have at least one that’s interesting. Below are pre and post procedure pics side-by-side. These are unfortunately different angles, but you can compare it with the pre-procedure CT scan above.
In the right-hand pic (after the flow diverter was inserted), you can see that
a) the big “berry” is gone
b) the artery is “straightened out”
c) the artery in which the flow diverter was inserted is actually “wider” than it was before. Specifically in the part of the artery in which the flow diverter was inserted.
d) most importantly, there is good blood flow downstream from the diverter.
My surgeon pointed out to me that the flow diverter was quite long. It apparently has to be long in order to anchor it. He actually had a better view of it than I was able to get a picture of. I think the picture I have shows too much of a bend on the far right end, I think that bend is really just the artery taking a turn.
The day before this final angiogram I was nervous about outcome #3. “What if it IS blocked?” “What if I have perpetual problems with this thing? I.e., like it continually blocks up?” So while I was waiting for the angiogram I asked another doctor if they could, in fact, go back in and “widen” it so the blood had more flow. That doctor said “no, it would be dangerous.” When he said that, I felt a little bit like I had been deceived a little bit. If you real my post above, you will see that I was told that this is possible and it helped me work through my anxiety.
When my neurosurgeon came to my room after this angiogram, I asked him the same question. He was more clear (a very clear guy). He said “Yes it is possible to go back in, but we have to ask what benefit it would be.” I guess the only way they would do that would be if the flow diverter was leaking somehow.
I also asked him “What happens to that flow diverter in the future?” He said that it becomes part of the artery. What really happens is that the body starts to build new artery wall around it, and that after 6 months, this is generally well underway or complete. He explained that it is more like a “mesh” that does two things:
- It sort of like when they lay down strings for oyster beds and the oysters start growing on them. The mesh provides something for the body to start building new arterial wall on.
- It doesn’t immediately (like with 1 minute) stop the flow into aneurysm, but it starts to divert the flow enough (encourage the blood to go in the right direction, and then the body starts building artery-cells onto that mesh and cover up the hole.
In my case I think it’s pretty clear that within two days the blood really started getting diverted away from the aneurysm; that’s why I had a headache after two days and needed steroids (He said the “berry” started to shrink.)
The fact that the artery is now wider than before is interesting to me. (Remember that the inside diameter of this artery is 1 millimeter to 1.5 millimeters. I’m not a doctor, but based on things my neurosurgeon was saying to me, the this flow diverter approach seems to hang on the issue of whether or not the artery is large enough to insert a catheter and flow diverter i. That was the initial question, before my first angiogram in October 2022. My neurosurgeon said initially that he was not sure he could get one into that artery, and it is typically not possible. But after the October angiogram he could see that my artery was actually swollen, and this swelling would enable him to get one in there.
I guess after insertion either the flow diverter or better blood pressure flow opened the artery up even wider. If you look at the picture. It does look “artificially straight” and we can see that it is wider were the flow diverter is inserted. FRED™ X | Microvention
For the record, what’s in there is a FRED X 21, 2.5 x 25 mm flow diverter. So that sucker is at least 25 mm long!
In case I did not mention it elsewhere, in October I did ask my neurosurgeon how we were going to fit a 2.5 mm tube into a 1.5 mm artery. He said that a) that was part of the challenge and why he was initially unsure about it and b) that these mesh devices are like Chinese finger puzzles: when you stretch them they elongate and narrow so that it actually narrowed down to less than 1.5 mm.
I think in many ways I am lucky. A few years earlier and this device really didn’t exist yet in this narrow a gauge. I also think I was lucky I lived in a city that had a surgeon that could put it in.
15 years ago, they would have had to take parts of my head off or said it was inoperable. If the former case I think I would have had a lot more neurological symptoms.
As my doctor was leaving my room I asked him when I had to come back.
His initial response was that he used to require that everyone come back after 5 years for a follow up. But at the the 5 year follow up no one ever had any problems!!! So he said come back in 10 years! He then said something about 3 or 2 years, and at that time they would just do a non-invasive MRI.
But then the nurses came by and they wanted clear discharge instructions. And I think the hospital settled on a policy of coming back in one year.
I am in general very pleased with everything that Swedish Hospital Cherry Hill did. I thought their nursing staff was great. I think they made a great decision to hire a specialist in endovascular procedures.
Light Sensitivity Issues
I did suggest to one of my nurses that they start selling a “kit” for dealing with blue and florescent light sensitivity. (They were questioning me about any neurologically symptoms, so I told them. ) The nurse actually said kit would be a good idea. (April 12th post for my suggested list.) The nurses (and even the doctors) seemed very open to the idea that either the blood thinners or procedures caused headaches and light sensitivity. (However, it seems like they don’t like to volunteer that information too much; apparently it is bad for business . . . . ) They did NOT seem open to all of my complaints such as fatigue. But the nurses at least listened to the idea of selling kits for dealing with the headaches.
So!! I am off the blood thinners now. First time in six months! I woke up feeling pretty good today.
I will keep posting in this forum to let people know if my light sensitivity and fatigue really were do to blood thinners. I am sure it is due to both. But we will see how much my energy returns now.
Best wishes to everyone!!
