Drs. Malek, Mueller treat brain aneurysms with Pipeline embolization device at St. Mary’s

Sep 13, 2022

On March 16, Dr. Ali Malek and Dr. Nils Mueller, interventional neurologists at St. Mary’s Medical Center, scrubbed in and treated three patients in a row who had large, life-threatening brain aneurysms. All three patients are doing fine, Malek said.

For the first time, the two used the Pipeline embolization device to treat the balloon-like expansions of weakened, major blood vessels. The cylindrical-shaped, wire mesh device is inserted into the patient via a catheter from the groin. The surgeons manipulate the device up into the brain to the opening of a large aneurysm. The device blocks blood flow to the aneurysm, causing blood within it to clot, which can prevent rupturing.

”It doesn’t go in the aneurysm. It lines the blood vessel that the aneurysm arises from,” Malek explained. “It prevents blood from going into it. Then the aneurysm basically shrivels up and goes away.”
The St. Mary’s physicians were the first in Palm Beach County to use the technique, Malek said. The only other hospital in the region performing the procedure at this point is the University of Miami.

“Until now, the way we’ve been fixing the aneurysm from the inside has been by filling them with [platinum] coils.

The problem with doing that is those metal coils will always be there forever,” Malek said. Filling a weakened blood vessel with metal coils stabilizes an aneurysm, but works best on smaller aneurysms, he said. “With a large aneurysm, where it’s putting pressure on a nerve or on a portion of the brain, if you fill it with platinum, it will decrease the likelihood of bleeding, [but] it will not decrease the pressure very much,” Malek said. That pressure can cause double vision, dizziness and other symptoms, Malek said.

The Food and Drug Administration approved the device last April for the treatment of large, giant and “wide-neck” aneurysms of the internal carotid artery that are 10 millimeters or larger, but doctors in Europe have used the device more broadly with success, according to Mueller.

“For a lot of these aneurysms, there was no treatment option at all,” Mueller said.
One treatment used sacrifices the artery, “but there are some arteries that cannot be sacrificed without causing a massive stroke,” Mueller said. “For patients with previously untreatable aneurysms, this is a revolutionary treatment option.”

In approving the Pipeline embolization device, the FDA reviewed a study of 108 patients treated with it. A year after implantation, 70 percent of aneurysms stayed blocked off without significant narrowing of the artery section treated. The study revealed that 10 strokes had occurred in nine patients during the 12-month follow-up period.

That number is less than the 20 percent rate expected for the condition, the FDA reported. Side effects included headache, bleeding, nausea and vision problems. People with an active infection, those who
cannot take blood-thinning medication and people with previously ruptured aneurysms are not candidates for the Pipeline procedure.

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