Hi there. I have now seen probably the top two docs in our area, and am not sure how to progress as they have opposing viewpoints of my best treatment. Both agree I need it treated, so at least I know I’ve got to do something. The first thinks stent-assisted coiling is best. They feel that because of my need for life-long warfarin that clipping would be a bit risky. They have assured me my risks with the stent and coils are very small. I trust their judgment. Then yesterday I went to the 2nd place. The surgeon there thinks clipping is my best bet. He works with patients on lifelong Warfarin all the time so doesn’t see it as a big deal. He actually put my surgical risk of the worst things (stroke, paralysis, death) at LESS than 1%. I was shocked! His 2nd choice is Pipeline but he hasn’t had a patient with my specific clotting disorder do pipeline so it’d be uncharted territory. He does NOT think stent and coiling is a good idea. I trust him as well.
So iit leaves me in a bit of a pickle. I think I’m taking Pipeline off the table, so really having to choose between clipping and stent/coils. Naturally i do NOT like the idea of a craniotomy, but would do it if it was clearly best option. My husband thinks I should get a 3rd opinion. I feel like I should either do that or just believe that either way is okay and pick one. They are both saying their procedure is low risk. They are both extremely respected in this field. Any advice?
Thank you,
Karen
Karen,
Do both doctors perform both procedures? I know that I did a lot of research regarding both procedures and due to my age and I found that the risks were about the same. I had decided before meeting with my neurosurgeon at all that I wanted the clipping surgery if it was an option for me. As it turned out, my aneurysm was not a candidate for coiling at all. I have another small one being watched and I will choose clipping again if it is able to be done. You may want a 3rd opinion and I would make sure that they perform both procedures, so that they aren't biased one way or the other.
~ Carol
Thanks Carol. At the first place I met with the neurosurgeon and the interventional radiologist and they agreed stent and coils best, even the surgeon. At the 2nd place he does both, although I believe he does clipping mostly.
This is tough Karen...maybe a third opinion is better...did they tell you coiling is less invasive then clipping...?
Btw ... where it the aneurysm and how big is it ? Just curious...~ sending out some prayers to you Karen...I know this has got to be tough ~ Colleen
Thanks for replying, Colleen. 5mm carotid artery near opthamalic nerve I think? (Behind left eye). First place says coils wont put pressure on optic nerve but 2nd place says it might. I currently am not having any problems with that eye, so first doc says that means I shouldn’t have problems with the coils. They also disagree about safety of Neuroform stent in my situation.
Thanks for sharing the information Karene...I had a 9mm basilar artery tip aneurysm...although they do clipping for it...they would rather do coiling because risks are high with clipping in that artery...that is why I asked you at this point...I have a 2 mm behind my opthamalic nerve...at this point watching because too small...and I have never asked about treatment because I am hoping it doesn't grow...
I do hope you get more input from people here at BAF ... but in the end, Know it is your decision...and I will keep you close in my thoughts ~ Colleen
Who did you go to at the 2nd place? I met with four different surgeons, so I don't think a 3rd opinion is a bad idea. For me, based on my age (38 at time of surgery) the doctors were hesitant to do Pipeline because that procedure is pretty young. The stent used in the brain has been around roughly 15 years. They did not know the long term. If I was over 65 they would have gone with Pipeline.
Do you see a doctor for your clotting disorder? If so, you might want to check with him/her regarding the clipping. See if they feel it is too much of a risk. Also, I would also research it on my own. As I do not have a clotting disorder, I can not give an opinion on that. I will say that between Pipeline and clipping, after doing tons of research, I felt clipping was the best option.
Terri
Thanks Terri. I know you saw dr. Newell and dr. Sekhar - could you tell me who the other 2 were?
Dr. Sekhar was the 2nd doctor. He gave some good reasons for clipping, but I am very scared of it. I am not really considering Pipeline at this point. Really choosing between stent and coils or clipping. I don’t think my regular doctor would provide much help in the matter. I’d much prefer to do stent and coils, but would like to be more reassured this is good, since Dr. Sekhar didn’t seem to think it was. The team at Swedish sees no big problem with stent and coils. So trying to find someone who may be able to provide yet another point of view. 
Hi Karene,
Doesn't it figure, nothing is cut and dry ! I do think I'd ask for the 3rd opinion...and I'd want to know why one doctor sees no problems with the clipping and the Warfarin verses why does the other one see an issue. Another point blank question I'd want to ask each doctor is exactly how many of these procedures have they got under their belts....(It is a fair question_)...
Although the coils/stents are truly lifesaving devices, the fact that the clipping is seen as the 'Gold Standard" in the treatment of aneurysms and the fact that they're not subject to the things that the coils are subjected to (compaction, moving, etc) I am one to go for the clip, hands down. Also, if coiled, theres the constant monitoring of them with Angiograms to make sure nothing is wrong (which is great, just hope nothing is going awry) , and the threat of serious headaches after the placement of the coils/stents is another reason that I'd for go coils if I were given the choice. I was lucky that when my coils did indeed compact and sent me back into the hospital, my Neurosurgeon was able to perform a clipping since sometimes after coils have been placed, its impossible for the surgeoun to go back in and do a clip afterward, (depending on where/how the coils were originally placed the first time around) ...
Its a lot more invasive for sure, recovery time is longer, but for me it was the right way to go. Good luck on seeking the answers Karene, Peace, Janet
I'm not sure what clotting problem you have but prior to my surgery it was deemed that my blood was toooo thick and the Plavix was not doing anything.They gave me Effient and 4 baby aspirin to take before they put the Pipeline in. 6 hours later I was laughing it up in ICU...on Facebook and eating!!! I realize I will probably be on Effient and aspirin for life but...I am so relieved they did not do coils because of all the stuff I heard about them compacting and having to go back and have that fixed - ugh. The pipeline is a permanent solution as is the clipping - but IMHO the pipeline is the way to go - no craniotomy!! Good luck with whatever you decide.
I replied in your other post. I saw Dr. Ghodke at Harborview. He is a coiling specialist. He was the second doctor I saw. The first doctor (who does open surgery) thought I was a good candidate for coiling. He sent me to see Dr. Ghodke. Based on the MRI/MRA, Dr. Ghodke thought coiling was a good idea. After the angiogram, he referred me back to a surgeon to discuss clipping. Due to the size and shape of my annie, I would need a pipeline. He was very hesitant based on my age though. He said that if I was around 65 he would do the pipeline.
Terri
They needed to put the pipeline in for me because the neck of my annie was very wide. I'm 10 years younger than you and had no problem. I practically begged my neurosurgeon to do the pipeline - based on all the positive reports I had read. But each case is different and I'm sure your neurosurgeon knows whats best.
Just scheduled my appt for 3rd (and hopefully final) opinion for next week. Thank goodness. Really hoping this points me in the right direction and helps me make a decision on treatment. Wish me luck!!
Good luck! 3rds the charm! :) Let us know what he says!