Today I got the results of and MRA that was done this past Friday. A bit of background first. 3 years ago I suffered a ruptured AcomA Aneurysm that was roughly 4x5 mm with a wide neck. My recovery was slow at first but I am now back to my normal daily life. Completely self sufficient, working full time and even back on my Motorcycle. Since my rupture I have had 3 Angiograms, 3 MRAs and 4 CT Scans.
The first 6 months angiogram showed slight coil compaction. The 12 months angiogram showed further compaction. At 18 months there was a residual aneurysm of 4mm wide by 2 mm depth. All subsequent tests have been about the same. This last test on Friday 8/16/2013 shows very little change if any from the past 3 tests over an 18 month period.
I was once again given two options. Continue to watch it, or try a treatment of more coils and stents. 3 different doctors at different places all said the same thing after reviewing my case. Due to the location, size and shape of the residual aneurysm, it would be a very dangerous procedure. The neck of the aneurysm is twice as large as the depth. They could probably block the aneurysm completely, but complications such as stroke would be very high. I have included an image of the very odd shaped aneurysm so you know what I am dealing with. (Click on attachment below)
For me it was an easy choice. I have a pretty good quality of life. Why risk all that I have gone through for a procedure that may help a future rupture, but has a high likelihood of having debilitating results. So for now its more waiting and testing, and in the mean time I live my life and I am grateful for being alive and well.
I am curious though, what would some of you do faced with this same situation?
Just based on what you wrote,I would discuss clipping. My aneurysm was also anterior communicating artery. Bulging in two spots (think Mickey Mouse ears) with a very wide neck. I chose clipping. A big thing for me was having it over and done with. Yes, the risks are a little higher with clipping, but the “fix” was a big deal for me.
Terri, I am not sure if you checked out the image I attched, but like you said, Mikey Mouse Ears. I should have mentioned clipping is not an option for me due to the location, shape, existing coils and how the aneurysm sits in the artery. Thanks for your response.
I may be confronting the same situation in 2014 Tony...told almost 1 year ago...that my coils compacted and a slight amount of blood feeding the annie...they said they would do nothing for 2 years because so much trauma was done and my parent vessel was accidentally cut ... so I needed to heal...I have some situations, I am learning to live with...and loving life everyday...I really can't say what I would, but at this moment...I would opt for "watching and waiting"...You have a great attitude Tony...and know all the risks...I think sometimes we must make the best decisions that "WE" are comfortable with....not any one else...Gotcha in my Thoughts ~ Colleen
Good questions. It all happened very quickly as I had ruptured. One moment I was perfectly fine and the next I am in an ambulance rushing down the freeway. I knew nothing about brain aneurysms and didn’t have much time to study up. A neurologist, neurosurgeon and endovascular surgeon stood around me and my family and basically said it didn’t look good. They all agreed coiling should be tried first for all kinds of reasons and that if it wasn’t working out, they would wheel me into surgery.
I read the endovascular guys procedure report months later. The coiling was very difficult and he had to try several different approaches to get the first could in place. There was a very sharp angle to work with, a very short artery overall, and another major artery was right next to the aneurysm. So he didn’t want to take the chance of a stent blocking that. The balloon assisted placement also failed with the balloon repeatedly popping into the aneurysm. So I ended up with coils and no stent. The initial angiogram shows 100% obliteration of the aneurysm.
For all the above reasons, they are still reluctant to place a stent or even try another procedure including clipping. Thanks for responding!
Sorry to hear about the aneurysm regrowth, but very glad to hear it isn't growing more and that otherwise you've made an excellent recovery. I think someone can only do what feels right for themselves... I think there are probably extremely solid statistical arguments for letting sleeping dogs lie and just getting on with life... but I usually verge on the paranoid, so I'd probably be inclined to pursue a riskier surgery so that I could feel more at ease in the longer term. I suppose it's all a matter of perspective - it sounds like you have a great attitude towards the whole affair and I'd wager the statistics favour leaving it alone like you are choosing to do.
Tony...thanks for your response...you were so blessed...I mean I am not exaggerating that one...
One of the questions I have asked in "ask the doc" is the tortuosity of our arteries...the aneurysm parent artery and the access arteries... yet awaiting an answer...
You've jabbed my curiosity...the FDA approved stents for concomitant use w/coiling of wideneck to prevent coil retraction into the parent artery...which suggests stents would be the first implant...to protect / avoid retraction of any coils. or to make the decision of open surgery/clip...
I have such a strong interest in the stents...due to the off-label, off-record, stent implants around, near, by, the not-wideneck aneurysm...w/no other early need for stents (e.g. plaque)
Blessings for your continued wonderful life and for comfort in any future decisions...and, for a great weekend...
While not faced with exactly the same thing I sorta know how you feel. My neurosurgeon was concerned w/some dizzy issues I was having. After having the angiogram it was discovered the coils in my 7.4mm Annie had compacted. My dr was very informative with the options. Clipping was possible & a more permanent solution. The down side was that where the Annie is located is very close to the main vessel that carries blood to my brain. Also very close to the nerves that control my facial muscles and being able to swallow. Or we could go back & add more coils. I opted for more coils & will be having it done a week from today. At some point clipping maybe the only way to go. Right now I’m looking at this procedure as maintenance. You put gas in the car well I have to have coils in my head. I looked at the picture & all I can say is Wow. Wishing peace to you.
As you can see by this image of the residual aneurysm, a clip simply won't work in this case. One of the downsides of having gone the coil route, is that in some cases it does not leave enough room for a future clip to seal off the aneurysm without blocking the vessel itself.
As for Pat's question about stents, once a stent is placed, it pretty much rules out any future use of a clip from being used on the same aneurysm. At least that is what I am told. Stents are used in "tortuous" arteries and would be needed in my case should more coils become necessary. But there are risks involved with stents as you mentioned.
Here is a different angle that may give you a better understanding of the issue. A stent would have to be placed along the length of the aneurysm and across the main artery that feeds the two others. And according to all the docs, there is no room for a clip.
hi Tony! My sah was 4 yrs ago, recoiled 8 mnths post. Recoils occluded 100% and was never told it would be dangerous, what are they recommending? is it leaking? I can't quite understand --they coiled with such great success but they are reluctant to add few more? Well since the last 2 years are not showing more compaction I would do the same. I was told to never put head lower than the heart by the occ therapist, once I forgot and was looking under the bed and I felt a surge that scared me when I recalled her words, I'll never do that again! Keeping you in thoughts and prayers for all the best~
Your coiling is remarkable and significant compared to mine...one of these days I will share some images...perhaps I should have said unremarkable and insignificant...
There is a lot of confusion on this forum about the word "leaking" as it related to aneurysms. Some use it to describe blood circulation back into the aneurysm or between the coils (canalization). Others use the term as blood leaking out of the artery and aneurysm which is actually a SAH (rupture) which is life threatening and requires immediate medical attention.
In my case, the problem is that the coils have compacted and the aneurysm has changed shape allowing blood flow back into the neck of the aneurysm (which some would inaccurately call leaking). Now due to the location and shape of the aneurysm it may be "too dangerous" to treat because the addition of a stent may block other main arteries. Or the coils may not stay put because of the very wide neck to depth ratio.
It is not "dangerous" for most people to have additional coils. It all depends on your anatomy.
hi Pat! i have no clue which artery, i assume it was on the right since my whole left side is affected, i suppose i could get my records but i'm not really interested, i think the ptsd has made me extremely disinterested- i cant look at my x-rays even! Much like a war veteran dislikes war movies i suppose. Who knows maybe i will change in my Ostrich like behavior- they stick their head in the sand thinking they avoided danger and all is well!
Thanks for uploading the images, I can see how a clip would be out of the question at this point -- and thanks for clearing up some info on how/why the stent is used, as it wasn't quite clear to me.
I agree, I wouldn't want to undergo a procedure that comes with such a dicey possible outcome- considering you're feeling quite well and you've come so far after your rupture... knowing that 3 seperate opinions have all reached the same conclusion, plus no real change in the past 18 months on your scans...nope, ..I wouldn't touch it. Peace , Janet
