Innovative Stroke Prevention Techniques Help a Woman Beat the Odds

Forty-five-year-old Rebecca Flynn is a fit, energetic and healthy-looking mother of two. She has never smoked, she watches her diet and exercises. On the surface, she doesn’t appear to be someone who is at high risk for suffering a stroke. But over a three-year period starting in 2006, Flynn had brain surgery twice to treat an aneurysm lurking behind the optic nerve in her left eye.

An aneurysm occurs when a blood vessel weakens and part of its wall begins to bulge, resembling a balloon slowly filling with air. Sometimes an aneurysm will lie dormant for years, without causing any problems. But if it bursts, causing blood to flow into the brain, it results in a life-threatening condition called hemorrhagic stroke.

Flynn’s unexpected journey started in May 2006, when her 45-year-old sister was rushed to the hospital after suffering a devastating stroke that left her permanently disabled. Doctors confirmed that her stroke was caused by a ruptured aneurysm, and advised Flynn to get screened right away—people with a family history of aneurysm, particularly a parent or sibling, are at much higher risk themselves.

“While I was shocked by what happened to my sister, I didn’t believe it could also happen to me and I put off having the test until August,” said Flynn. “I was stunned when I received a phone call informing me that I was indeed living with an aneurysm—and it was located in the same exact spot where my sister’s had ruptured.”

A race against time

Flynn quickly sought treatment advice from Christopher Uchiyama, MD, the Scripps Green Hospital physician who had diagnosed her aneurysm. Based on the aneurysm’s location and the techniques available at that time, he recommended an interventional procedure calling aneurysm clipping. To try and cut off blood flow to the aneurysm, he would need to remove a piece of her skull before navigating through her brain tissue to clamp a tiny metal clip at the base of the aneurysm.

“I knew brain surgery came with a lot of risk, but I felt it was just as risky to live with what was essentially a ticking time bomb in my head,” said Flynn. “I trusted Dr. Uchiyama’s judgment and decided to have the procedure.”

While Flynn survived the surgery, she was not entirely out of the woods. As a result of the aneurysm’s location, it could only be partially clipped—meaning it was still a threat. And its precarious position behind her optic nerve also caused permanent blindness in her left eye.

Additionally, the recovery from such an invasive procedure was long and difficult—Flynn said it took nearly a year-and-a-half before the side effects from surgery, including headaches and memory problems, diminished. She sought the opinions of other experts in San Diego and Los Angeles who all said the same thing: they couldn’t offer her any additional treatment due to the significant risks of having repeat surgeries so close together. She had no choice but to take a wait-and-see approach—and hope that the aneurysm wouldn’t grow or burst.

A world of difference

Three years later, Flynn once again found herself facing the possibility of brain surgery. Thanks to an imaging test called an angiogram, Dr. Uchiyama discovered that the aneurysm had tripled in size. He referred her to his new colleague Rene Sanchez-Mejia, MD, who had recently joined Scripps Green Hospital as the head of cerebrovascular and endovascular surgery.

A Harvard Medical School graduate with fellowship training in endovascular (minimally invasive) brain surgery, Dr. Sanchez-Mejia is uniquely qualified to perform both open brain surgery as well as newer, less invasive techniques that reduce pain, scarring, and healing time.

After a thorough study of Flynn’s medical history including the location of her aneurysm and her prior history of brain surgery, Dr. Sanchez-Mejia recommended an endovascular procedure called aneurysm coiling. During the procedure a thin, flexible tube called a catheter is threaded through the patient’s blood vessels, starting in the groin and ending in the brain. Once the catheter reaches the weakened blood vessel, it guides a tiny platinum coil into the aneurysm; as the coil fills the bulging vessel it essentially blocks blood flow, rendering it unable to burst.

In October 2009, Flynn’s aneurysm was successfully treated with endovascular coiling—making her one of only a handful of people in the world who have been treated with both open and minimally-invasive brain surgery.

“The difference between the two surgeries was incredible,” said Flynn. “When I woke up after the coiling procedure, I felt amazing—like I was cured. I checked into the hospital on a Thursday and was home by Monday, up and walking around like nothing had happened.”

While Flynn may feel cured, her susceptibility to cerebral aneurysms means she will need to have routine angiograms for the rest of her life; fortunately, her most recent angiogram in May 2010 confirmed that the aneurysm treated by Dr. Sanchez-Mejia is completely gone. Flynn also understands the importance of managing her controllable stroke risk factors like weight, blood pressure, and cholesterol.

“I would recommend both Dr. Uchiyama and Dr. Sanchez-Mejia in a heart beat,” said Flynn. “They have so much talent and drive, and I was awed by the amount of research they did before both of my surgeries. There was no ego or arrogance behind their decisions—they truly cared about me and my outcome.

“Even though I was nervous about the procedures, I never felt unsafe or unsure of the quality of care I was receiving,” Flynn added. “I was amazed by how careful and diligent the caregivers were, and I feel very lucky to have been a Scripps Green patient.”