I Give Dr. P Two Thumbs Up!
It all started back in January, when she first heard a ringing in her ear. “My mom passed away in the beginning of November and after that I was chewing a lot of gum to manage stress and to cope,” Asnath recalls, “so I thought that might have been it. An ENT specialist suggested I undergo an MRI, and the doctor who read it told me I had an aneurysm! I said, ‘Wait, what? Isn’t that a big thing?’”
Asnath was right to worry — an aneurysm can be serious if it ruptures and bleeds into the brain. But there are treatments available to repair aneurysms and greatly reduce the risk of a future rupture.
“When most people think of an aneurysm, they think of the rupture,” says Dr. Patsalides. “In actuality, an aneurysm refers to a weakness in the three-layered wall of an artery that forms a little bubble off the vessel. Think of it like a tire — the bubble can get bigger and weaker over time and lead to a blowout. An aneurysm is the same; the bubble off the wall of the artery can lead to a rupture. Not all aneurysms rupture — a high percentage of them don’t. But any aneurysm requires careful evaluation to determine the degree of risk.”
After she learned of the aneurysm, her doctor recommended she schedule a consultation with Dr. Patsalides. “I remember when I saw Dr. P he was very clear and reassuring. He told me what was going on, showed me where it was, and said that ‘It would be treated.’ That stuck with me. I especially liked that he said treated instead of saying I’d have a big surgery.” After the consultation, Asnath underwent an angiogram — a diagnostic test that uses x-rays to capture photos of the blood vessels and the aneurysm. “That’s when I found out I had two aneurysms! An oddly shaped big one and a small one. I named them ‘Annie and her daughter,’” she laughs. “Just so this wouldn’t feel as big as it was.”
Just a few decades ago, a neurosurgeon would have performed a craniotomy – removing part of Asnath’s skull – to “clip” the base of the aneurysm, closing off the bubble and preventing any further pressure against the wall. More recently, interventional neuroradiologists have developed a way to repair these aneurysms without opening the skull – they thread a tiny wire into a blood vessel in the thigh up to the brain, where they guide it to the aneurysm. They then “coil” the aneurysm – filling the bubble with coils of miniature wires that prevent blood from entering it. The procedure is painless and recovery is quick.
Coiling has become the preferred procedure, but there are some aneurysms that don’t lend themselves to this new repair. The coiling procedure works best on aneurysms with the classic “berry” shape – with a narrow neck, like a balloon. Asnath’s larger aneurysm, however, was a “wide-neck, fusiform” aneurysm that – until very recently – would require a major open surgery to be treated effectively.
“Our preference is always to go the minimally invasive route,” says Dr. Patsalides. “Luckily, to do that for Asnath, and to spare her the full craniotomy, there is a brand-new tool we can use, a tool developed specifically for these fusiform wide-neck aneurysms. The Surpass device was only recently approved by the FDA. Due to the location of Asnath’s aneurysms it was of the utmost importance that we have it and were well-versed in how to use it. I strive to give my patients my best, always.”
The Surpass flow diverter is a new mesh stent system designed for wide-neck aneurysms that are not suitable for coiling. “It is inserted into a blood vessel in the thigh or the wrist, like the coiling device,” says Dr. Patsalides. “We thread it up to the aneurysm and position it at its wide neck, then we expand it. Once the stent is in position, fitted snugly into the blood vessel, blood flow is diverted away from the aneurysm.”
Since the Surpass device was brand new, Dr. Patsalides needed extra time not just to procure it but also to become surgically proficient with it. “He didn’t tell me that’s why my surgery was rescheduled. He just said he ‘needed something special,’” Asnath laughs. “It’s as if he’s treating you before you even have the procedure — when you have something blood related, you don’t want to be stressed out. He’s so gifted — I’m just thankful his hands are able to do this to treat his patients.”
Asnath went into surgery on June 19, 2019. She remembers waking up in recovery with a sense of clarity. “I asked him immediately,” recalls Asnath, “Did you get both of them?” Sitting at her bedside, Dr. Patsalides nodded and smiled. “She was so happy after I nodded,” he remembers, “she gave me a high five!”
It took Asnath about two weeks to fully recover – far less than the recovery time for a craniotomy – and she says she slept a lot to kick the fatigue and headache. I’m okay now,” she says. “That an incision in my leg treated what was going on in my head… that’s crazy to me! When it was happening, I didn’t even tell anyone what I was going through. You tell people you have an aneurysm in your brain and you don’t know how they’ll react! I give Dr. P two thumbs up — I thank God for him because he’s an amazing doctor. I felt special. He really cares about his patients.”