Surgery scheduled and looking for advice

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Hello!

I’m following up from a previous thread where I was asking for advice. I’ve narrowed my search and have decided to travel to NYC for my care to retreat my ruptured aneurysm that was coiled in 2024. My cerebral angiogram from April 2026 showed that the aneurysm was growing and the coil was starting to unravel. After consulting with 5 other neurosurgeons/neurointerventional radiologists, I’ve selected the team at Weill Cornell/NYP for the procedure.

I had my consult with Dr. Philip Stieg but he recommended I meet with his colleague, Dr. Jared Knopman, who could offer the endovascular options. He didn’t think I needed open surgery (which was inline for 4 of my other consultations) and highly recommended Dr. Knopman.

I felt comfortable with Dr. Knopman’s approach to do a Stent-Assisted Coil Embolization (Atlas Stent) and will have the procedure later this month!

I’m wondering if anyone here has had a re-treatment from Dr. Knopman and if you have any insights as I prepare for my upcoming surgery.

During that consultation, I also learned two important pieces I will carry into my ongoing recovery:

  1. I had never heard the recommendation of taking 81mg of asprin ongoing to help with inflammation - I wish I had know that in 2024! But grateful to have that insight now to hopefully prevent any reoccurrence in the future!

  2. My current neuro has only done cerebral angiograms, never MRAs, but it sounds like my new protocol with be MRA first and then cerebral angiograms if they see anything they’d like to further investigate. Does anyone have experience with doing MRAs vs. cerebral angiograms? I didn’t know there were options and I’m optimistic that a less invasive annual routine could be in my future.

Thank you all! So grateful for this group and these conversations.

Rosie

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Can’t help with Dr. Knopman as I live in NC and have always been treated by Dr. Stacey Quintero Wolfe at AHWFBH in Winston’s Salem. Hopefully someone here knows him.

I always have gotten an MRA and sometimes the MRI and MRA before an angiogram. They are not at all the same. MRI machines that the patient lays on a table and goes into a tight place with lots of sounds as it takes the images. The surgeon orders the images, the Radiology tech gets the images done and the Radiologist looks them over and reports their findings, The imaging allows the surgeon to see what may be going on, the angiogram gives a definitive diagnosis. Since Dr. Q-W teaches the Radiology class how to read them, she looks the actual images over herself. Found this https://youtu.be/CwjJsSkRfMQ?is=lYSfe_ajBAbS6W5W. Sometimes MRs are done with and without contrast. Contrast is a dye that allows for better imaging. And found this https://youtu.be/p6ZiBkPZDrc?is=3HMPZ4kDZIKP17To that explains them all. The only thing I’d say is my MR’s used to be quite long, especially if having both done. The newer machines I’ve been in have been very fast at around 15 minutes total for both. Best thing is for me, no radiation as I’ve had quite a lot since I ruptured.

Angiograms have always been considered as the gold standard. It always has contrast dye used. My angiograms have always been done by my surgeon. She send the catheter up either the femoral artery or the radial artery gets it around my heart and up into my brain. Found this that explains the angiogram and the differences https://youtu.be/UmVTtm4wRyA?is=0hT4bRXSlK0oqE_F

Hope this helps explain things better. I quite agree on having the MR is much nicer than having an angiogram :joy:

I was actually taken off the 81mg aspirin I had been on for a very long time after I ruptured and was told to be very careful with NSAIDs. I wasn’t put back on it until I received my stent annd was taken off Plavix. Always check and follow your surgeon’s instructions.

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Morning @rosie!

I am so happy to hear that you found someone you are comfortable with to help you moving forward. That matters more than anything else!!

My medical care is out of Philly, so I do not have any experience to share with Dr. Knopman. My super brief history is rupture, coils and then a stent put in a little later out (I had a Pipeline instead of an Atlas), and a whole lot of other drama in between.

  1. At least for me, I am on “baby aspirin for life!” Welcome to the club! :smiling_face_with_three_hearts: I also went on another blood-thinner (clopidogrel) for a month prior to the surgery and was on it for a few months afterwards until my aneurysm was declared occluded. This is known as DAPT for dual anti-platelet therapy.

Your medications of course may be different depending on how your body reacts. For me, being on the two, bruises were very common, and I also experienced a bad nosebleed (note it was also winter here on the East Coast so the air, of course, was very dry not like our humidity in the summer). I was able to get the nosebleeds under control by using a saline spray and that helped tremendously.

  1. Throughout my journey I have had a few MRAs and angiograms. Funny you should mention but I just scheduled my first “check-up” MRA (post-occlusion aka death of the aneurysm) for later this month. In my mind though, I - perhaps unfairly - liken MRAs to MRIs more than angiograms.

I appreciate that this comes from a provider, but I liked the layperson approach to the similarities and differences between MRAs and MRIs.

MRAs are definitely less invasive than angiograms, and - logically - it makes sense that a doctor would do those first to see if there is a real need to do angiogram since obviously that is more involved (the team’s schedule, your time, anesthesia, etc.).

In terms of having a stent, well, it is similar to having an angiogram. We do have some prior postings about stents, but I opted for this one but there are others out there too if you have some other question, as we talk a little bit more about the stent procedure generally, along with what discharge instructions are generally like.

Please let us know what questions you have or what we can do to help support you!

Fin Whale Fan :whale:

P.S. Just for planning purposes, with the NYC/NJ area being in the thick of World Cup, just wanted to provide some links so you can plan appropriately since it may impact your visit.

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Hi @rosie

I’m glad you found a Neurosurgeon that you like. I ruptured in October 2020, got my coils and was retreated six months later with additional coils and a stent. It wasn’t as bad as I thought it would be. Regarding the Aspirin, I think the protocol states a dual anti platelet medication Plavix and Aspirin, that you should start taking prior to the procedure and about six months after, you stop the Plavix and the Aspirin dose gradually decreases and you will stay on 81 mg Aspirin for the rest of your life. Perhaps the protocol is different for an Atlas Stent….., my stent is a Codman stent.

I will be thinking of you and I wish you all the best.

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Hi Rosie! I’ve had two MRA’s instead of angiograms to follow-up yearly for my anuerysm. I wanted MRA because i’ve been exposed to too much radiation the last few years with two cervical fusions a year apart and tons of x-rays then the initial angiogram to see what the aneurysm looked like , then another angiogram when they put in the WEB device. I don’t want to start glowing in the dark! My surgeon was fine with me getting a MRA instead and it’s much faster than a MRI :grin:

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I have the Neuroform Atlas Stent. Sounds like procedures may be the same with whichever stent one gets?

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14 June 2026 no one to welcome
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I had a rupture in 2010 and was retreated with a stent and more coils 2 years ago. The retreatment was a breeze and I was out the next day and on with my life. I take 325mG aspirin daily, but this isn’t for inflammation. It is to keep the blood thin so it doesn’t clot along the stent. I was taking 81mg before the stent, but after the initial coils.

As for MRIs, MRAs and angiograms, I’ve had more than I care to remember. The angiograms are the most invasive, but not all that bad. However they are the gold standard for seeing what’s happing within the arteries. That said, the new T3 MRI/MRA machines take incredibly detailed images.

Best of luck to you.