Brain Surgery without the Surgery?

Every 45 seconds, another American has a stroke, caused either by a blocked or burst blood vessel in the brain. And every three minutes, one of them will die.

That's the bad news.

The good news? Doctors can do more than ever to find and fix the problems that cause many strokes - before a stroke ever happens. And they can do it without ever having to open up the skull.

New technologies, delivered to the brain via the bloodstream and guided by more powerful brain scans, are making it easier to clear up clogged blood vessels inside our heads, or shore up weakened ones.

It's brain surgery without the surgery, also called minimally invasive, or endovascular treatment. And according to University of Michigan Health System doctors who perform such procedures on hundreds of patients a year, it's allowing many patients to reduce their risk of a stroke - including those who wouldn't be able to withstand a brain operation.

One of the newest options is the first device designed to help doctors open up clogged blood vessels in the brain. Called the Wingspan intracranial stent, it's a tiny wire mesh tube that can be fed into the body through an incision in the leg, threaded up through the blood vessels in the chest and neck, and inserted into the brain.

The U-M team is one of the first in the United States to treat patients with this device, which can help people who have not yet suffered a stroke or who have had a "mini-stroke", also called a TIA. It's designed for patients with a condition called intracranial stenosis, or cerebral atherosclerosis: a narrowing or hardening of the arteries in the brain. The condition is linked to the same factors - high cholesterol, high blood pressure, smoking, obesity, diabetes - that play a role in many heart attacks. Just like in the heart, the condition causes narrowing or blockage in brain blood vessels.

"This offers us the first option designed specifically to treat this condition," says Joseph Gemmete, M.D., director of interventional neuroradiology at U-M and an assistant professor of radiology. "This is a very high-risk condition, with patients facing as much as a one-in-three chance of suffering a stroke in the next year. We had been using stents designed for arteries in the body, but this is specifically for the brain."

Another common cause of stroke is burst blood vessels, which cause massive bleeding (hemorrhage) inside the brain and rob the brain of oxygen, causing a stroke. The vessels usually burst open at weak spots in their walls, often at a bulging spot called an aneurysm or a tangled web of abnormal vessels called an arteriovenous malformation or AVM.

"These, too, can be treated without open surgery, says U-M neurosurgeon B. Gregory Thompson, M.D., head of cerebrovascular and endovascular neurosurgery at U-M who performs both open-cranial microsurgery and minimally invasive endovascular procedures.