E.B. Writers of Dallas

Wayne Epperson, correspondent | Pulse Magazine, a Dallas Morning News publication, June 2003

Florean Yarbrough is among the fortunate few whose cerebral aneurysm was detected and treated before rupturing.

Non-hemorrhaging cerebral aneurysms are detected in only 5 percent to 10 percent of cases. The significance of that number is magnified by a grim statistic: When aneurysms hemorrhage, roughly 50 percent of the victims do not survive.

"I was one of the lucky ones, very lucky," says Mrs. Yarbrough, a 64-year-old retired Arlington ISD school bus driver who lives in Fort Worth. "I didn't even know I had an aneurysm."

Last August, Mrs. Yarbrough began having dizzy spells. She went to her primary physician and, after tests and an X-ray, was told she had "a little blockage in the artery" on the left side on her neck.

Her primary physician ordered more tests, including an angiogram, which she had on Jan. 3 to try and determine the cause of her dizziness. The results of the angiogram revealed an aneurysm (a weak bulging spot on the wall of an artery in her head) and were forwarded to neurosurgeon Dr. George B. Crisp.

He recommended that Mrs. Yarbrough go to Fort Worth to see Dr. B.J. Gralino, a vascular interventional radiologist with Radiology Associates of Tarrant County, who was doing endovascular coiling.

After weighing all her options and their statistics, Mrs. Yarbrough decided to have the nonsurgical coiling treatment.

Dr. Gralino performed endovascular coiling on Mrs. Yarbrough's aneurysm on March 11. She was one of the first patients to undergo the procedure at Harris Methodist Fort Worth Hospital's new Neurointerventional Radiology Suite, a part of the Vascular and Interventional Radiology Center. The $5 million suite, made possible by gifts from the Sid W. Richardson Foundation and the Ryan Foundation, is part of the hospital's state-of-the-art Neuroscience Center of Excellence. It is the first medical facility of its kind in Tarrant County. Previously, patients had to be transferred to Dallas for the coiling procedure.

Approved by the Federal Drug Administration in 1997, aneurysm coiling gets its name from the device used in the procedure, the Guglielmi detachable coil (GDC). During the procedure, a small incision is made in the patient's groin, a needle is run into the femoral artery and a catheter is threaded through the needle. A bi-planar fluoroscopy unit provides three-dimensional images of the aneurysm as the radiologist carefully guides the GDC through the catheter into the brain and to the aneurysm.

Soft platinum wire spirals about the thickness of a human hair and shaped like a Slinky are attached to the GDC by a solder joint. Once the coil is released into the aneurysm, a current is passed through the wire, which helps induce a blood clot in the aneurysm and detaches the coil at the solder joint. The blood clot signals that the goal of the coil is achieved and the threat of hemorrhage has been isolated. The coil stays in the aneurysm.

Mrs. Yarbrough's procedure was done under general anesthesia and lasted less than three and a half hours.

"I stayed in ICU overnight and went home the next morning, " she says.
While coiling is designed to be a primary treatment option for an aneurysm, it also can be an adjunct to surgery.

Some patients are too sick to undergo clipping, the surgical means of dealing with an aneurysm. In this procedure, a metal clip is secured around the base of the aneurysm to separate it from the blood vessel.

"Now we are able to coil an aneurysm as a temporizing measure. If we can prevent that aneurysm from re-hemorrhaging by putting a coil within it, maybe we can get the patient to wake up and improve .… Then we can either do a formal coiling or a formal operation," explains Dr. Thomas Ellis, a neuro and cranial base surgeon with the Fort Worth Brain & Spine Institute.

He calls the images from the bi-planar machine "amazing."

"It is a quantum leap over standard angiography and it really helps me in my surgical planning to see and understand the nuances of an aneurysm I am going to be clipping. The better prepared you are, the easier things go," he says.

Surgery still is by far the leading method of aneurysm treatment in the United States, with 75 percent of cases being clipped and 25 percent coiled.