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Release: Oct. 25, 2002
Research results show new technique for treating brain aneurysms is superior
of a study in the Oct. 26 issue of The Lancet show that researchers -- including
a member of a University of Iowa Health Care team -- have determined that
a new approach to treating ruptured aneurysms in the brain is superior to
Researchers at 44 medical centers in Australia, Europe and North America
participated in the International Subarachnoid Aneurysm Trial (ISAT). The
study's investigators ended the trial early because the early results definitively
showed that the new technique achieved better outcomes for patients than traditional
A brain aneurysm is an abnormal bulging outward of the wall of an artery.
The defect is most common among people between ages 35 and 60. Brain aneurysms
can cause a stroke when they rupture and blood flows into the brain or the
space closely surrounding the brain.
The traditional treatment for a ruptured brain aneurysm was surgery. Neurosurgeons
placed metal clips across the neck of the aneurysm in an effort to stop arterial
blood from escaping into the brain.
In contrast to surgery, a less-invasive approach uses a technique called
endovascular treatment. An interventional neuroradiologist inserts a small
plastic tube called a catheter through an incision in the patient's leg into
the femoral artery. The interventional neuroradiologist then uses X-ray guidance
to navigate the catheter through the vascular system into the brain and inside
the aneurysm. Next, the interventional neuroradiologist threads tiny platinum
coils through the catheter into the aneurysm, obstructing the blood flow into
Researchers say that the ISAT results indicate that treating ruptured brain
aneurysms with coils called embolization - results in better outcomes
for patients when compared to the surgical placement of clips.
John C. Chaloupka, M.D., University of Iowa professor of radiology and director
of the Interventional Neuroradiology Service at UI Hospitals and Clinics,
is an internationally recognized expert in the endovascular treatment of brain
aneurysms. He has served in various advisory and scientific capacities for
several endovascular clinical trials, including a recently proposed international
clinical trial comparing the outcomes of clipping versus coiling of unruptured
aneurysms called the International Study of Unruptured Intracranial Aneurysms
"The ISAT results provide a very important, albeit preliminary step,
in changing the basic management paradigms of intracranial aneurysms, which
will eventually transition endovascular techniques into a first line or primary
treatment modality," Chaloupka said.
Chaloupka is one of the first physicians in the world to deploy micro-coils
in brain aneurysms. Specialists at the UCLA Medical Center developed the technique
from 1990 to 1991. For more than a decade, Chaloupka has performed several
hundred micro-coil embolization procedures. Currently, UI Health Care specialists
led by Chaloupka perform between 100 and 120 micro-coil embolizations to treat
brain aneurysms each year, making UI Hospitals and Clinics one of the nation's
leading centers for such procedures.
Investigators ended the ISAT study early when a planned analysis of the
early results showed that the data about the endovascular technique's superiority
were so convincing that to have continued enrolling patients would have been
Seon-Kyu Lee, M.D., currently a UI assistant professor of radiology, participated
in ISAT while he was at the University of Toronto. "Although we will
need to see the long-term outcome analysis of ISAT, the early-outcome results
of this study will now provide a nice opportunity for neurosurgeons and neurointerventional
radiologists to discuss evolving the management strategies for ruptured intracranial
aneurysms," Lee said.
A stroke occurs every 53 seconds in the United States, affecting nearly
600,000 Americans. One third of them will die as a result, making stroke the
nation's third leading cause of death, as well as the leading cause of severe,
long-term disability. Bleeding into the brain causes about two out every 10
strokes. The other eight out of 10 strokes involve blockages in arteries that
supply blood to the brain.
University of Iowa Health Care describes the partnership between
the University of Iowa Roy J. and Lucille A. Carver College of Medicine and
UI Hospitals and Clinics and the patient care, medical education and research
programs and services they provide. Visit UI Health Care online at www.uihealthcare.com.