Apollo Hospitals Navi Mumbai, one of the most advanced Multi-Speciality Tertiary Care hospitals in Maharashtra, showcased two unique complex cases with life-threatening brain aneurysms that were successfully treated by endovascular route with an advanced ‘Contour Device’. The patients could not be treated through conventional means due to location of aneurysms, wide neck nature of the aneurysm and medical co-morbidities. However, the interventional neurology team led by Dr. Vishal Chafale at Apollo Hospitals Navi Mumbai was able to effectively treat the patients using minimally invasive techniques and the innovative ‘Contour Device’ for occlusion of the aneurysm with minimal ICU and hospital stay.
Dr Vishal Chafale, Consultant, Interventional Neurology, Apollo Hospitals Navi Mumbai said, “A subarachnoid hemorrhage (SAH) is a type of stroke that is most commonly caused by a brain aneurysm in absence of any trauma. A brain aneurysm is an abnormal swelling or dilatation of part of the wall of an artery in the brain that can rupture and bleed into the space between the brain and the skull with risk to the life of the patient. While some of the aneurysms can be treated through open surgical techniques such as clipping and endovascular coiling, these patients had wide neck aneurysms, the treatment of which is challenging. However, today with interventional neurology and the innovative Contour device, we can successfully treat these patients and save their lives.”
Interventional neurology involves using minimally invasive, image-guided techniques to treat complex conditions of the brain, neck, and spine. In this case, the interventional neurologist threads a guide wire with the Contour device at the end through an artery in the patient’s groin to the site of the aneurysm. The Contour device is then deployed into the aneurysm so as to fill the aneurysm. The mesh then forms a clot to prevent any further bleeding and damage.
Mr. Santosh Marathe, Regional CEO Western Region at Apollo Hospitals added, “This was a successful case where, we have effectively used new devices such as “Contour” and “Web” available for treatment of wide neck aneurysms that are the most difficult to treat with the conventional methods. Such advancements in curative care have the potential to increase the life expectancy and the quality of life of the patients. We are elated with the efforts of our team of doctors and technicians that are bringing healthcare of international standards within the reach of every individual. Apollo Hospitals Navi Mumbai has a very comprehensive Department of neurology and neurosurgery with AI enabled stroke software with full-time dedicated senior clinicians. We are very happy that Apollo Hospitals, Navi Mumbai, a JCI accredited hospital has been successfully performing very complex minimally invasive endovascular procedures that needs minimal ICU and hospital stay.”
In the first case, a 58-year-old female developed sub-arachnoid hemorrhage (SAH) and was found to have a right internal carotid artery aneurysm. The patient was urgently shifted to Apollo Hospitals Navi Mumbai for further management. Advanced imaging with a cerebral digital subtraction angiography DSA with 3D rotation showed a wide neck bi-lobed aneurysm. It was treated with endovascular placement of Contour device. The patient did well and was discharged on the third day.
In the second case, a 62-year-old male developed SAH due to wide neck basilar tip aneurysm. A CT scan also showed subacute bilateral subdural hematoma. The regular treatment options such as simple or balloon assisted coiling were not possible due to too wide neck of the aneurysm, use of stent or flow diverter assisted coiling was also difficult in view of risk of subdural hematoma. He was finally successfully treated with deployment of Contour device. The patient had an uneventful recovery and was discharged after 4 days.
The Contour device is made of a dual-layer radiopaque nitinol memory mesh. Nitinol is a Nickel Titanium alloy and part of a class of shape memory alloys. Designed as a mesh in a unique shape, it both disrupts and diverts the blood flow away from the aneurysm. It is used to treat a range of aneurysms including wide-necked bifurcation and bifurcation aneurysms. Once in place, the mesh promotes thrombosis of aneurysm and prevent bleedings and subarachnoid hemorrhage.