Detecting and Treating Aneurysms
Dr. Dustin Hayward shares the symptoms of an aneurysm, if there are any risk factors, and treatment options available.
Melanie Cole (Host): Welcome. Today, we’re talking about detecting and treating aneurysms, and my guest is Dr. Dustin Hayward. He’s a neurosurgeon with EvergreenHealth. Dr. Hayward, it’s a pleasure to have you join us today. I’d like you to start by giving the listeners a little explanation of an aneurysm, what is it, and where does it occur in the body?
Dustin Hayward, MD (Guest): So, what I subspecialize in, aneurysms—the aneurysms that we are talking about are aneurysms of the brain—so cerebral aneurysms, and generally speaking, they’re located off of one of four major vessels, and that’s the two carotid arteries, the internal carotid arteries and also the two vertebral arteries, and these four major vessels are the ones that come up into our brain and branch at various points and these are the vessels that can be affected by cerebral aneurysms.
Host: Do we know how they develop?
Dr. Hayward: What they are is—they are weaknesses in the vessel wall, and if you could image, almost a balloon forming from a vessel wall. That kind of describes what an aneurysm is, but what causes them is a combination of nature and nurture. So, there is a hereditary component to cerebral aneurysms. Particularly, having a first degree relative that’s had a cerebral aneurysm predisposes that family member to having a cerebral aneurysm. So, they do run in families, and the nurture, the modifiable risk factors that people can have is one, we do see a higher incidence of aneurysms in smokers and then also in patients with high blood pressure, and obviously those are things that can be controlled. So, there’s a hereditary component, and then we do have some modifiable risk factors as well.
Host: Dr. Hayward, I’d like to talk about symptoms. I think that people get scared. They hear the word aneurysm, and is there any way to know in advance? Are there any symptoms then for people that get migraines regularly? You know, you get a headache, and you say, whoa, could this be something like that? Are those two connected at all? Are there any symptoms at all?
Dr. Hayward: So, that’s a great question. So, generally speaking, cerebral aneurysms don’t cause any symptoms. There are a couple specific scenarios where cerebral aneurysm would cause a symptom such as a pupil—a single pupil—dilating, or that single eye being affected so that it kind of points down and out—some effects on the extraocular muscles, but generally speaking, the vast majority of aneurysms are asymptomatic, meaning they don’t cause any symptoms whatsoever. That’s why it’s very important if you do have a family history of an aneurysm, what we’ll often do is offer screening services to patients, where we can get either an MR angiogram or a CT angiogram, just to confirm that there aren’t any aneurysms lurking around. Aneurysms do become symptomatic when they rupture, and then it’s usually described as a very severe thunderclap headache, and there can be some lethargy and alteration of consciousness with an aneurysm rupture. So, it’s always best when we find these aneurysms before that happens.
Host: Well, I would think so, and how scary, if someone does not have a family history of them. Can you find it incidentally when you’re having a routine physical? How are they detected if you don’t have a family history?
Dr. Hayward: Oftentimes, they are detected incidentally when an MRI or a CT of the head is done for another reason. So, let’s say somebody’s having some bad dizziness or vertigo, they’ll have an MRI or a CT performed to work up possible causes of that vertigo, and even though the aneurysm really has nothing to do with that symptom, we detect it that way, and when I see patients that have had aneurysms detected this way, obviously, finding out you have an aneurysm is a very anxiety-provoking experience, but when I see them, you know, I try to reassure them that this is the best possible way we could have found this aneurysm—is incidentally. We found it when it was still quiet and not doing anything and then that sets us up to be in a very good position to treat it and get it excluded from the circulation so that the patient will never have any issues with the aneurysm.
Host: Wow. That definitely is reassuring. So, assuming that you have found it, and it has not ruptured, tell us about some of the treatment options that are out there, and tell us a little bit about biplane technology and the benefits of using that for aneurysms. Tell us about this exciting technology.
Dr. Hayward: Absolutely. So, you know, traditionally, we used to have to do open surgery to treat all aneurysms, and this was kind of a technology and procedure that was developed all the way back in the 1930’s, and obviously, you know, the procedure was perfected and got much safer during the 20th century with the development of microscopes and intraoperative microscopic technology, but we used to have to do all aneurysm treatments with open surgery, meaning there’d be an incision, and a craniotomy—a portion of bone would be removed—and a dissection through the planes of the brain would need to be done to get to the aneurysm, where we would basically put a clip on it, and a clip is, you know, if you can imagine almost a clothespin that you put around the neck of the aneurysm, that’s what an aneurysm clip entails, an open surgical procedure and placement of the clip. Now, in the 1990’s, we developed technology based on the interventional radiology work that was being done, where we’re able to actually go inside the vessel. Specifically, we would enter the vessel, let’s say in the leg, similar to how the cardiologists will place stents or do angioplasties. We’d use the same access point of the femoral artery in the leg, and we go up with very small catheters—very small tubes—to where this aneurysm is in the brain, and then we have a variety of options. We can fill it with what we call coils, which are just small platinum pieces of thread that are pre-shaped into rounded, coil shapes, and we just fill the aneurysm almost with a ball of yarn—this ball of platinum coils. So, that’s one option we have.
We also have what’s called flow diverting technology, which is where we place a stent within the vessel, and it actually diverts blood flow away from the aneurysm and over time the aneurysm will clot and thrombose—so, essentially just to form a solid clot inside of it, and then the stent will incorporate into the blood vessel. So, you’ll actually grow new blood vessel over the neck of the aneurysm. So, to recap, we have open surgical clipping, a traditional technique, which is still used today. We have coil embolization, an endovascular technique that’s been around for the last 25 years, and then we also have flow-diverting technology, which has been around for the last 10 years, and all these are really excellent treatments for aneurysm that have various advantages and disadvantages over each other.
Host: Do you sometimes watch and wait, and if you do that, is there anything that they can do—lifestyle changes, anything that can minimize the risks of rupture, and how do you work with a patient if you decide that treatment is not necessarily necessary at that time? How could someone stand waiting?
Dr. Hayward: That’s a great question, and you know, really, the way I practice, and I think the way that we all approach the field of cerebrovascular medicine is what we’re seeking for the patient is the safest possible option. We’re seeking the way to basically keep them healthy, happy, and out of any real threat to the aneurysm, and essentially just safe. So, that’s a great point. If the aneurysm, let’s say, is very small, ok, like two or three millimeters, a very small aneurysm, then at that point, the risk of treating the aneurysm is greater, or excuse me, is less than the risk of treating the aneurysm. So, essentially, like you said, this is an aneurysm that we would recommend observation. We would just watch the aneurysm to see what it does because treatment is more risky than just leaving it alone. So, we usually watch these aneurysms over time with surveillance imaging, and what I mean by that is we get a CT angiogram once a year or an MR angiogram once a year, and that way, we’re able to keep an eye on the aneurysm over time, and if the aneurysm ever shows changes in either its size or its configuration, meaning it gets bigger or it forms a lobe or some sort of excrescence that looks like part of its wall is weakening, then, at that point, we can always move forward with treatment, but that’s how you know if we see a patient with an aneurysm that’s very small and non-threatening. We’ll watch it over time to make sure it doesn’t change, and things that patients can do to prevent aneurysm formation or the changing in size and shape of an aneurysm is one, getting the blood pressure checked, and this is a very ubiquitous problem throughout the modern day population is we do develop high blood pressure over time, and high blood pressure can cause a whole variety of medical problems, and not the least of which is it can cause aneurysm formation and aneurysm enlargement over time. So, regular checkups with your primary care doctor and even checking your blood pressure at home if you have a known history of high blood pressure to make sure that your blood pressure is controlled, and within a reasonable limit, and that’s a major thing you can do to prevent issues with aneurysms.
The other things, as I mentioned earlier, cigarette smoking and tobacco in general can cause inflammation of the blood vessels, aneurysm formation, and aneurysm enlargement. So, either stopping smoking or not starting is another thing that can be done to prevent aneurysm formation and growth, and the other thing is just, you know, amphetamine drugs and things like that that really elevate the blood pressure temporarily. Avoiding any medications or drugs like that is maybe the third thing that’s important.
Host: Do you have any final thoughts? Would you like to tell the listeners something that can help them understand, because it’s a bit mysterious? It involves the brain, you know, we don’t always really understand these things, and they’re a bit scary. So, let the listeners know what you would like them to know about treatment options for aneurysms and what you can do for them at EvergreenHealth.
Dr. Hayward: Yeah. Absolutely. I think, you know, what I would want, and what I do want my patients to know is that, you know, obviously, nobody wants these conditions. Nobody wants to have an aneurysm. Nobody really wants to have a neurosurgeon (laughs), you know, necessarily for these types of problems, but we have the technology and the ability to really treat these safely, and, you know, protect the patients from these problems. So, I think if the patient knows they have an aneurysm—if for whatever reason you know you have an aneurysm, absolutely, come In, be evaluated. We have all kinds of great technology—things that are even currently being developed, including the WEB device that are extremely—they’re safe and effective, you know. So, really, if anything, I just think, you know, a diagnosis of an aneurysm, nobody wants it, but at the same time, in the 21st century we’re very able to take care of patients and make sure they’re protected from these problems.
Host: What a fascinating topic and such great information, Dr. Hayward. Thank you so much for joining us, and that wraps up this episode of Check Up Chat with EvergreenHealth. Head on over to our website to learn more and to meet our team of providers. If you found this podcast as informative as I did—it was so interesting—please share on your social media. Share with friends and family. That way we can all learn from the experts at EvergreenHealth together, and don’t miss all the other fascinating podcasts in our library. Until next time, I’m Melanie Cole.