University of Buffalo doctor L.N. “Nick Hopkins” wants to snake a NiTi tipped catheter into your brain. That is, if you happen to have a non-drug responsive, high risk aneurysm. Applying technology that’s been in use all over the rest of the vasculature, cerebral stenting offers a “lets open up that skull of yours”-free option, but still needs some development work…
“The power of the new tools is extraordinary. Much of what we’re doing is not mainstream yet, but we’re headed toward a tipping point in care,” said Dr. L.N. “Nick” Hopkins, chief of neurosurgery at Kaleida Health and director of the Toshiba Stroke Research Center at the University at Buffalo.
But the brain is a more dangerous and difficult place to work. Despite progress, the new methods also fuel debate over when they should be used.
What’s worrisome to some is that much of the research so far has been funded by medical device makers, which may market new hardware before the risks and benefits are fully known.
Doctors want better information that comes from comparing one therapy against another in large numbers of randomly chosen patients.
“For much of this, the science isn’t there yet to tell us if patients do better with the new therapies,” said Dr. Thomas Tomsick, director of neuroradiology at the University of Cincinnati.
Even advocates, including Hopkins and Tomsick, advise a cautious approach.
“Some of the new therapies will work out, and some won’t,” said Dr. Kieran Murphy, director of interventional neuroradiology at Johns Hopkins Medical Center in Baltimore. “What we need, for patients, is national reporting of complication rates and good strategies for training the people who perform the procedures.”
Last year, Hopkins and his colleagues were the first in New York State to use the new Wingspan stent, the only device so far in the United States designed to treat intracranial clogged arteries, a condition that causes strokes in about 60,000 people a year.
Wingspan is made of a superelastic nickel and titanium alloy called nitinol, which can curve and taper to navigate the brain’s smaller, tortuous vessels.
“We’re wrestling with ways to come up with a safer operation,” said Hopkins, who noted that there’s no technology small enough yet to collect the debris that the stent can knock off smaller vessels.
Several studies indicate treating burst aneurysms with coils offers some patients better long-term survival than major brain surgery, although most aneurysms continue to be treated with clips. One other study suggests coiling can provide better results than clipping for unruptured aneurysms.
Physicians continue to argue over the research, making decisions difficult for patients.
McCarthy spent weeks researching what therapy to get and where to get it before opting for the stent-and-coil procedure.
The decision also involves weighing the risk of rupture against the risk of therapy. Only an estimated 1 percent of aneurysms burst, but when a rupture occurs, there is a more than 50 percent chance of death.
“I kept asking people, “Where is the factory that does the most of these?'” said McCarthy, a retired Kodak manager from Skaneateles.
More power to them. It seems they’re being appropriately cautious not to over-sell the technique as an aneurysmal panacea. Still, if they can appropriately micro-machine the right materials to perform inter-cerebral stenting smoothly, it’s that many fewer skulls that don’t get openned up.
On another note, it’s interesting to see the press interjecting bits about conflict of interest into otherwise introductory/congratulatory light sci/tech pieces. They’ve finally taken notice (or taken notice that the public has taken notice) that most drug or device research is either funded or performed by parties with a vested interest. Of course, it’s not like there’s anyone else lining up to fund billions of dollars in research a year.
More from The Buffalo News
The Wingspan Stent from Boston Scientific (and it’s Humanitarian Device Approval from the FDA)
Flashback: Wingspan™: A Solution to Strokes