By Daniel Dunaief
Danielle Santilli grappled with numerous discomforts, from headaches to nausea to dizziness, especially when she traveled in a car or stood up quickly. After a series of tests, however, she learned she had a wide-necked bifurcation aneurysm, which is one of the more common types of aneurysms.
A diagnosis that has potentially severe consequences, an aneurysm is an area in a blood vessel that grows like a balloon. If it ruptures, it can cause dangerous bleeding.
Santilli became a patient of Stony Brook Medicine’s interventional radiologist and professor of neurological surgery and radiology David Fiorella. Santilli was thrilled with the timing, as Fiorella was a co-principal investigator on a recently completed U.S. Food and Drug Administration study for a minimally invasive surgical technique that involves implanting a Woven EndoBridge or WEB.
“I feel very fortunate,” Santilli said of the opportunity to be one of the first to receive the treatment.
The FDA approved the use of the WEB in January. European doctors have used it effectively since 2011.
The WEB is a spherical structure that’s braided out of fine-shaped memory filaments of metal called nitinol, which is a combination of nickel and titanium. The WEB behaves more like a rubber band than a paper clip and wants to return to its original shape. Doctors insert it into a microcatheter in the femoral artery near the groin. Once they release it in an aneurysm and stretch it out, the WEB expands into a spherical shape inside the blood vessel.
The body grows new tissue over the aneurysm neck along the metal mesh, which is akin to sealing off a well.
The alternative for people with this type of aneurysm can often involve more invasive, open-brained surgery, Fiorella said.
The procedure takes about 40 minutes and often requires a one-night hospital stay. Patients with a WEB procedure also require aspirin for a short period, compared with six months of a blood thinner and then aspirin for much longer periods for other surgical alternatives.
Fiorella explained that there were two types of aneurysms. An unruptured version typically doesn’t have any symptoms. Doctors usually discover these through a screening for other symptoms or because of a family history. Patients in this group sometimes receive scans for different and unrelated reasons.
Robert Walsh, a 66-year-old retiree and resident of South Jamesport, went to a doctor to check himself out after his younger sister died earlier this year from an aneurysm. Tests revealed that he, too, had an aneurysm.
A month after his sister died, Walsh had the WEB procedure.
Fiorella and his staff “are probably the best I’ve ever encountered,” Walsh said. “I’m impressed with him and his entire staff for everything they did, with follow-ups, calling in prescriptions, getting my pre-op ready. I have a lot of confidence in Dr. Fiorella.”
People with a ruptured aneurysm are dealing with bleeding into their brain. This typically causes symptoms like the worst headache people have ever had, vomiting or a loss of consciousness of rapid neurological deterioration.
The survival rate for people in these circumstances is lower and depends on whether they make it to the hospital.
The WEB is helpful for patients who have a ruptured aneurysm. Other techniques, such as stents, are not usable for patients under these conditions.
“A lot of other tools are off the table” with a ruptured aneurysm, but the WEB is “very effective,” Fiorella said.
Some potential patients with a wide-necked bifurcation may not be good candidates for a WEB because their aneurysm is too small or too large for the device.
Stony Brook has extensive experience with the WEB. Doctors who want to perform a similar procedure at other hospitals need extensive training from experienced physicians who can prepare them for the procedure.
Long Island residents should know they have a “major center right here that’s doing work that surpasses anything going on in Long Island or, in most cases, in the city” with endovascular surgery, Fiorella said.
Santilli feels the doctor “saved my life,” and is delighted that she “doesn’t have to worry about using a blood thinner.”
The procedure changed the way Santilli and her family live. They are making healthier lifestyle choices. She and her husband Frank are cutting back on smoking, and she is also buying fruit instead of sugary snacks for the house.
Santilli said she feels fortunate that Fiorella was able to perform the procedure.
“I feel like I got a second chance,” she said.