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February 12th, 2009
11:40 AM ET

How long will an aneurysm repair last?

As a new feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. Here’s a question for Dr. Gupta.

Asked by Isabel, Lancaster, California

I had cerebral aneurysm in 2001 and now have two titanium aneurysm clips in my head. How long do these clips last? Do they at some point in time get loose and I will have a hemorrhage again? I've always wondered about this. "

Answer:

 Hi Isabel, I am so glad that it sounds like you are doing well. The type of operation you are describing is one that I have done many times, as recently as this week. As you may know, cerebral or brain vessel aneurysms are sort of like blisters on the wall of the blood vessel. They are little bulges where the blood vessel becomes weak.

The concern is they can start to leak blood slowly into the brain or they can rupture, causing a large amount of bleeding, called a subarachnoid hemorrhage. If that happens, the patient is likely to experience what is known as a thunderclap headache. This is not an ordinary headache. These come on suddenly and are often described as the worst headache of the individual's life. I had one patient describe it as if someone came up and struck him in the head with a baseball bat. A CT scan will reveal the blood in the brain and a lumbar puncture test will show blood in the cerebrospinal fluid, which is the fluid that bathes and nourishes the brain and spinal cord. Unfortunately many patients will suffer permanent neurological deficits or die after a cerebral aneurysm rupture.

 The goal for the operation is to fix that blister, and to reconstruct the weakened vessel so there is no more bleeding. This operation has to be done quickly, because the highest likelihood of the aneurysm bleeding again is in the first few days. And that gets us to your question, Isabel.

The titanium clips you had placed have been studied for many decades. There is a very low likelihood they will come loose or that the aneurysm will come back, if the clips were placed satisfactorily at the time of your operation. Your doctors probably recommended an angiogram to check that around the time of your operation and in follow-up. One large study says the chance of re-bleeding is less than 1 percent. So, you should be in good shape. Do make sure your clips are MRI compatible should you ever need an MRI, but don't worry about setting off airport detectors or other metal detectors.


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