Two days after Christmas, Chelsea Gatcliffe, a pediatric resident at the University of Miami, had a rare day off.
A healthy 27-year-old with no medical problems, Gatcliffe decided to hit the gym. She was on the treadmill when she suddenly developed a searing headache and grew dizzy. Before she knew it, Gatcliffe had passed out.
Fortunately, the gym was in her Brickell apartment building, and Gatcliffe managed to drag herself up to her apartment. Her headache intensified, and she began vomiting.
Gatcliffe called her brother, a surgeon at Baptist Hospital, who rushed over with her parents. They immediately drove her to Baptist Hospital. That’s the last thing Gatcliffe remembers. The next day, she came to in the intensive care unit, intubated. That’s when she learned she had suffered an aneurysm.
Aneurysms are a bulging or ballooning in the wall of an artery, primarily in the heart or the brain. The condition is rare, affecting between two and 16 people per 100,000 annually. They’re also potentially deadly.
People can go for years without knowing they have an aneurysm until it suddenly ruptures. When this happens in the brain, it causes what people say is the worst headache of their lives, followed by a loss of consciousness or a coma. If not treated quickly, the result can be fatal. Some aneurysms are not discovered until an autopsy is done. Studies have shown 1 to 9 percent of the general population dies of the condition.
Aneurysms are one type of abnormal brain lesion that can lead to a potentially fatal rupture. Another is called an Arteriovenus Malformation (AVM), which is also extremely rare, affecting just one in 100,000 people annually, with 3,000 new cases diagnosed every year.
An AVM is essentially an abnormal tangle of arteries and veins in the brain that is cut off from capillaries, and therefore, oxygen. Similarly to aneurysms, people can live with AVMs for years with no symptoms and then experience a rupture that can be fatal. Also like aneurysms, AVMs are sometimes found in autopsies.
Up until recently, doctors had few options in treating aneurysms and AVMs. Once the condition was discovered in imaging studies, the only recourse was to cut away the lesion or diseased area through brain surgery — a dangerous and invasive procedure.
“We have made some great advancements in the treatment of aneurysms in the last 15 years,” said Dr. Italo Linfante, medical director of interventional neuroradiology and endovascular neurosurgery at Miami Cardiac and Vascular Institute and Baptist Health Neuroscience Institute. “Instead of opening the skull to find the brain vessel and fix it, we repair it from the inside.”
For aneurysms, two new treatments have been developed in recent years.
In easier cases, where the aneurysm is smaller than two centimeters, the surgeon inserts a hollow plastic tube into an artery in the groin and threads it through the body to the aneurysm. The surgeon then pushes a wire coil inside the aneurysm, disrupting the blood flow and causing the blood to clot. The clot essentially seals off the aneurysm from the artery.
The second procedure involves what is called a flow diverter and is used for larger aneurysms. The stent-like device is placed inside the artery in the aneurysm’s base. The idea is to divert blood flow away from the aneurysm and into the blood vessel, which slows down the flow into the aneurysm and essentially rebuilds the blood vessel.
Doctors at Baptist Hospital have performed more than 100 cases with flow diverters in the last three years.
“We’ve had wonderful results with this new procedure,” Linfante said. “In the vast majority of patients, the aneurysm shuts down very quickly.”
Linfante treated Gatcliffe with the flow diverter. Before undergoing the procedure, she was placed on blood thinners for 24 hours in the ICU.
Today, Gatcliffe is recovered and back to work. Because the condition can be genetic, doctors advised her siblings to be tested through brain imaging tests.
“They say I was probably born with this, and it just got bigger,” Gatcliffe said. “I know I was in the right place at the right time. I was lucky.”
Another patient who had luck on her side was Saira Anwer. A 25-year-old NBC television anchor from North Dakota who had no medical problems, Anwer was on her way to a skiing trip with friends in January when her car hit a patch of ice and flipped.
Suffering a cut on her head, Anwer was taken to the emergency room, where she underwent a CT scan of her brain and an MRI. At first, doctors thought she had a bleed in her brain but ultimately decided to discharge her.
The next day, a neurologist called and notified her she had an AVM.
“He said this was an incidental finding, and less than 1 percent of the population has this and that it was kind of lucky I had the car accident,” Anwer said. “He said you need to get it out.”
Anwer informed her aunt, a nurse at Memorial Healthcare System in Hollywood, who persuaded her to fly to Hollywood and be treated at Memorial. Memorial treates about 25 AVM cases a year. In early August, Dr. Hoang D. Duong, director of neuroradiology at Memorial, treated her.
“I’ve been doing AVMs for 20 years, and each case is very different,” Duong said. “They are different sizes and in different locations. You can’t generalize about AVMs.”
In Anwer’s case, she underwent an embolization, in which a catheter with dye was inserted through her groin to the carotid artery in her neck. This enabled the doctors to create a map of the arteries, veins and blood vessels in her brain. Then, glue was injected through the catheter into the AVM to cut off circulation to it.
Sometimes, when the AVM is under 2.5 centimeters, this is all that is needed to get rid of the AVM. However, in Anwer’s case, the AVM was bigger and surgery was necessary. The following day, the surgeon removed the AVM, which was located in her right temporal lobe.
“We knew she was a perfect candidate,” Duong said. “She had a perfect recovery. She’s very lucky she caught this so young.”
In some tougher cases, when the AVM is in a primary motor area of the brain, surgery is not an option. In those cases, radiation and a “Gamma Knife” are used to destroy the lesion.
Anwer is now recovering at her aunt’s house and thankful she had that car accident, as strange as it sounds.
“You hope you never have to have brain surgery,” Anwer said. “But I’m lucky this was caught when I was so young.”