By Dr Vipul Gupta, Director – Neurointerventional Surgery, Sir H.N. Reliance Foundation Hospital, Mumbai
Cerebral aneurysms are abnormal balloon-like dilations of blood vessels in the brain that develop due to weakening of the vessel wall. These aneurysms are extremely dangerous because they can rupture without warning, leading to severe internal bleeding in the brain known as subarachnoid hemorrhage (SAH). SAH is a medical emergency with a high risk of death and long-term disability. If timely treatment is not provided, the chances of re-bleeding are significant, and survival rates drop drastically.
Ruptured cerebral aneurysms demand immediate intervention. Re-bleeding after the first rupture is one of the most critical factors contributing to mortality. Early and definitive treatment can be truly life-saving.
In earlier decades, open brain surgery was the only available option to treat aneurysms. While effective in some cases, surgical clipping involved opening the skull and manipulating delicate brain tissue, which carried considerable risks, longer recovery time, and higher chances of complications. The evolution of endovascular techniques has dramatically changed this landscape.
Today, most aneurysms can be treated through minimally invasive endovascular procedures, particularly aneurysm coiling. In this technique, doctors navigate a microcatheter from an artery in the leg up to the brain and place detachable platinum coils inside the aneurysm. These coils block blood flow into the aneurysm, significantly reducing the risk of re-rupture. This approach minimizes trauma to healthy brain tissue, shortens hospital stay, and improves overall patient outcomes, making it especially valuable in emergency situations.
However, not all aneurysms are suitable for coiling. Certain aneurysms are large, wide-necked, irregularly shaped, or located in critical areas where coils alone may not provide durable protection. For such complex and high-risk cases, flow diverter stents have emerged as a breakthrough, particularly in emergency and high-stakes scenarios.
Flow diverter stents are advanced endovascular devices designed to reconstruct the damaged blood vessel itself rather than filling the aneurysm. These cylindrical, fine-mesh metallic stents are placed across the neck of the aneurysm within the parent artery. By redirecting blood flow away from the aneurysm, they allow the aneurysm to gradually seal off and heal over time, dramatically reducing the risk of rupture or re-bleeding.
In emergency settings, flow diverter devices are proving to be highly beneficial for patients with aneurysms that are otherwise difficult or unsafe to treat. They offer a durable, vessel-preserving solution that can stabilize critically ill patients and prevent catastrophic bleeding, often when time is the most crucial factor.
The latest advancement in this field is the new-generation flow diverter technology, such as the Pipeline Vantage device. Unlike earlier devices that could only be used in larger brain vessels, this new generation can be delivered through thinner microcatheters, allowing treatment of aneurysms located in smaller and more delicate blood vessels. Despite their reduced size, these devices are engineered with layered wire construction, ensuring excellent visibility during fluoroscopy and precise placement by the treating physician.
Additionally, these stents are coated with advanced surface technology that significantly reduces the risk of clot formation. This allows doctors to use lower doses of anti-platelet medications—an important advantage in emergency cases where excessive blood thinning can increase bleeding risks. As a result, patient safety is further enhanced during the most critical phase of treatment.
With the integration of cutting-edge flow diverter stents into emergency neurointervention, doctors are now better equipped than ever to manage complex and life-threatening brain aneurysms. These innovations represent a major leap forward in saving lives, reducing complications, and improving long-term outcomes for patients facing one of the most dangerous neurological emergencies.