Breakthrough procedure allows aneurysm patients to go home the same day

LaDel Hoyle
LaDel Hoyle of West Des Moines

For LaDel Hoyle of West Des Moines, Iowa, it was a Monday morning that began like any other.

In January 2015, LaDel arrived for her job in the gift shop at a local restaurant, but soon she began feeling disoriented and experiencing memory lapses. She didn’t faint or fall, but clearly something was wrong.

“My manager later told me I kept repeating, ‘I’m confused’ and asking, ‘What time is it?’” LaDel says. “I don’t remember any of that.”

Co-workers contacted LaDel’s brother, Mark, who took her to the emergency department at a West Des Moines hospital. LaDel underwent numerous tests and was kept overnight for observation.

An MRI the next day showed that LaDel had an unruptured cerebral aneurysm—a thin spot on a blood vessel in the brain that bulges and fills with blood. An aneurysm can put pressure on a nerve or tissue in the brain, or even burst into a life-threatening hemorrhage that spills blood into surrounding tissue.

LaDel’s primary care physician referred her to University of Iowa Hospitals & Clinics, where she met neurosurgeon David Hasan, MD, an expert in the treatment of aneurysms and other vascular conditions of the brain and spinal cord.

Hasan told LaDel she was a good candidate for a new, minimally invasive procedure using the Pipeline Embolization Device, a specialized stent implanted across the neck of the aneurysm to prevent blood flow into the aneurysm and allow the damaged blood vessel to heal.

After talking with her family and family doctor, LaDel was “all in.”

“I just wanted to get it over and done with,” she says.

For years, standard treatment for cerebral aneurysms required a craniotomy—surgery to remove part of the bone from the skull to access the brain. It’s a complex, delicate procedure where patients are hospitalized for several days post-surgery, followed by four to six weeks of recovery at home.

Pipeline Embolization Device procedure illustration

To implant the Pipeline device, a catheter is inserted into an artery in the groin and threaded into the carotid artery, which supplies blood to the brain. A braided wire mesh tube at the tip of the catheter is positioned across the neck of the aneurysm. The blood remaining in the blocked aneurysm forms a clot that reduces the likelihood of the aneurysm rupturing or enlarging. In fact, aneurysms treated with the Pipeline typically will shrink over time.

“This gives us an effective alternative to open surgery,” Hasan says. “Any patient with an elective (unruptured) cerebral aneurysm is a good candidate for this procedure.”

When the Pipeline technique first came into practice, surgical teams used general anesthesia, and patients stayed in the hospital overnight. Recently, Hasan and his colleagues have performed the procedure with patients under conscious sedation. The medical team has perfected the technique to where the procedure typically takes a little more than an hour.

Even more remarkable, the need for overnight observation has been eliminated—most patients are able to go home the same day.

A few hours after her Pipeline procedure, LaDel was cleared to go home—“great news” for her and her family, she says. Moreover, she felt only minimal pain. In fact, she didn’t need her prescribed pain medication in the days afterward; an over-the-counter pain reliever was enough.

LaDel remains impressed with the procedure and the care she received.

“The doctors and nurses were with me the whole way. I couldn’t have asked for a better team,” LaDel says.

The Pipeline approach “really is a breakthrough in aneurysm treatment,” Hasan says. “The ability to take it from a very complex surgery to a much simpler outpatient procedure is very comforting for patients and their referring providers. It’s an example of how here at Iowa we’re always trying to be innovative, to be leaders. And we’ve done quite a few of these cases to back our claims.”

— David Pedersen
Fall 2015