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Brain Aneurysms 101 with Dr. Asif Taqi

Living a healthy lifestyle requires adequate exercise and nutritious food, as well as awareness about potential health risks, such as brain aneurysms. In the United States, approximately 8 to 10 individuals per 100,000 will experience a ruptured aneurysm annually. The incidence of unruptured intracranial aneurysms ranges from 0.2% to 10% of the population, though these values are often determined via autopsy studies and can be subjective. Most commonly found in adults, aneurysms can also occur in children. While neurological conditions can be a source of anxiety for individuals of all ages, many people are uninformed about aneurysms. Here, Thousand Oaks leading neurointerventionalist and stroke specialist Dr. Asif Taqi covers the basics. 

Q. What is a brain aneurysm?

A. An aneurysm presents as an abnormal enlargement on the arterial wall in the shape that often resembles an inflated hot air balloon. An aneurysm may form due to arterial wall weakening. 

The main types of aneurysms are named for their specific differing shapes: saccular, fusiform, and dissecting. Saccular aneurysms, the most common, are aptly named for a sac or dome-like appearance. Fusiform aneurysms are identified for how the aneurysm bulges out on all sides of the vessel—as though a straw was forced through the center of a blueberry. Lastly, a dissecting aneurysm occurs as the result of a tear in the blood vessel wall which allows blood to enter the tear and expand. 

Q. What are the symptoms of a brain aneurysm?

A. In many instances, brain aneurysms are asymptomatic, though some patients present to the Emergency Room with what they believe is the “worst headache” they have ever experienced. Symptoms vary among patients, depending on the condition of the aneurysm. With unruptured bulges, the severity of symptoms depends on the size and location of the aneurysm, especially if the bulge is found to be pressing on brain tissues or nerves. This type of aneurysm may manifest itself in the form of headaches, dizziness, eye pain, difficulty with vision and/or seizures. 

Q. How are brain aneurysms diagnosed?

A. Aneurysms are often discovered via computerized tomography angiography (CTA) or magnetic resonance angiography (MRA). Unruptured bulges are diagnosed incidentally, as onset symptoms may resemble an unrelated medical condition—typically a routine image will catch the disease. 

Q. Are brain aneurysms life-threatening?

A. A bulge can grow in size over time, and in doing so, the walls of the artery may become so weak and the blood pressure may become so high that the dome may leak or burst. This event is particularly life-threatening, as untimely treatment may result in a major neurological disability—and in 40% of cases, a ruptured aneurysm is fatal. 

A ruptured aneurysm releases blood flow into the spaces surrounding the brain; this is called a subarachnoid hemorrhage (SAH). SAH is a type of stroke that occurs instantaneously. Symptoms can be severe headache, nausea, vomiting or loss of consciousness. Under these conditions urgent treatment is necessary. 

Q. What are the risk factors of a brain aneurysm?

A. Some risk factors are modifiable, and some are not. For instance, individuals who smoke, abuse drugs and/or alcohol and have high blood pressure are more susceptible. Unlike the aforementioned controllable behaviors, there are risk factors that may not be mitigated, like gender—aneurysms manifest among the female population with more frequency than males—familial history, personal previous history of aneurysm and other genetic syndromes. 

Q. How is a brain aneurysm treated?

A. Health care professionals distinguish between ruptured and unruptured aneurysms, as the course of treatment will depend on this distinction. There are two well-established treatment options for patients diagnosed with intracranial aneurysms: surgical clipping and endovascular coiling. Neurosurgical intervention requires an open skull surgery called a craniotomy followed by dissecting the brain to reach the aneurysm. 

Endovascular coiling is performed using the patient’s vascular system to reach and treat the aneurysm. Access to the brain aneurysm is gained through the femoral or radial artery with the assistance of imaging guidance. Because all arteries in the body connect, an interventionalist may run a small catheter to the aneurysm and can fill it with tiny, flexible metal coils. During this procedure, the “coiling” aspect is what occludes the aneurysm space and prevents it from rupture. 

More recent advanced technology in endovascular treatment of brain aneurysms allows an interventionalist to place a flow-diverting stent across the aneurysm to effectively close it out. The procedure carries only a 1% to 3% risk of any complications and takes between 30 minutes to an hour on average to complete. Most patients who undergo this procedure go home the day after.

Post-operative monitoring is imperative. From discharge, patients are closely monitored by the operating physician, as regular imaging follow-ups and prescription medication will ensure that the patient continues to live a long and healthy life. 

Q. Are there any recent advances in the treatment of brain aneurysms?

A. Dr. Taqi made local history last year when he used the Comaneci Embolization Assist Device for the first time in the United States to save a patient’s life. Designed to offer a less invasive option to traditional surgery, the Comaneci device can be used to treat aneurysms with wider than normal dimensions.

Dr. Taqi leads several national and international clinical trials as Principal Investigator to advance treatment of brain aneurysms.

Dr. Taqi's newest endeavor is Balt's STEM Study, which aims to treat chronic subdural hematomas. He also invests in the betterment of clinical trial efficacy by participating as a member of Clinical Events Committees—his most recent membership includes the ELEVATE IDE Study.

To learn more, contact Dr. Taqi at 805.242.4884 or visit VNSC.org.

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