Miller School Neurosurgeon Stays on Leading Edge of Aneurysm Treatments

A 77-year-old retired physician is back to enjoying her life after a Miller School of Medicine neurosurgeon repaired two dangerous aneurysms in her brain using leading-edge medical devices.

“It would have been almost impossible to treat her aneurysms without this new technology,” said Robert M. Starke, M.D., professor of neurological surgery and neuroradiology, co-director of endovascular neurosurgery with the University of Miami Health System and UM/Jackson Memorial Hospital, and director of neurovascular research.

A rotational 3D angiographic model of aneurysms successfully treated with WEB.

Dr. Starke used the Woven EndoBridge (WEB) Aneurysm Embolization System, a self-expanding mesh ball implant, to treat the patient’s wide-neck cerebral aneurysms. “We were able to close both aneurysms and she went home the next day,” he said. Months after the November procedure, the patient, who requested anonymity, is doing fine.

The WEB implant was approved last year by the U.S. Food and Drug Administration. It is designed to disrupt the blood flow entering the aneurysm and help promote clotting (thrombosis). It is similar to a number of the advanced devices Dr. Starke has helped design, develop and test in his Miller School laboratory. “These many options for patients allow us to be world leaders in the treatment of cerebral aneurysms,” he said.

Aneurysms are weakened, bulging areas in the arteries and veins that can cause bleeding in the brain or rupture, resulting in life-threatening strokes or other medical problems.  They affect millions of Americans who may experience symptoms like severe headaches or vision problems, or have no symptoms at all.

“We can use coils and stents to obstruct the flow of blood into an aneurysm with a narrow neck in an easily accessible location,” said Dr. Starke. “But when the aneurysm has a wide neck or an unusual configuration, a typical coil or stent won’t close the vessel. Not all patients can be treated with open and more invasive surgical clipping.”

In patients with complex aneurysms, the WEB device acts as a plug in the aneurysm, expanding as needed to block the blood flow. “It can also be used when a coil is unlikely to hold because the base of the vessel is uneven or irregularly shaped,” said Dr. Starke. “The WEB system can also be a good option for treatment if the aneurysm occurs at the intersection of two or more blood vessels.”

The Woven EndoBridge (WEB) Aneurysm Embolization System.

Dr. Starke recently completed a clinical trial of the PulseRider, a self-expanding scaffold for treating wide-necked aneurysms at or near branching areas of arteries in the brain. “It opens up, like a flower, holds the coils in place, and sometimes works better than a stent,” he said. “Depending on the nature and location of the aneurysm, the PulseRider can be as effective as the WEB system, and we are one of the few neurosurgical practices in Florida that offers both options to patients.”

The Miller School is one of 15 academic centers in the U.S. involved in an upcoming clinical trial of a blood flow-diverting stent with surface modifications. “The goal of these modifications is to decrease the chance of clot formation and improve the chances of aneurysm obliteration,” said Dr. Starke, who will be leading the clinical trial of the new stent, which is already in use in Europe.

“This stent could potentially reduce the risk of stroke because it has a special coating to prevent the formation of blood clots that can travel to the brain while the aneurysm is being treated,” said Dr. Starke. “Our goal in the trial is to continue evaluating whether this stent is a better treatment option for aneurysms.”

Tags: cerebral aneurysm, Dr. Robert M. Starke, Woven EndoBridge