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New Stroke Prevention Treatment May Fill The Bill

Tribune photo by VICTOR JUNCO

Nasser Razack, director of Interventional Neuroradiology at Bayfront Medical Center in St. Petersburg, holds a syringe containing Onyx, a substance used to fill brain aneurysms.

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By IRENE MAHER

News Channel 8 Medical Editor

Published: July 10, 2008

Doctors have a new weapon in the battle to prevent strokes. It looks like black ink and acts like a firm putty once inside the body. The substance is appropriately called Onyx, and it is used to fill brain aneurysms, a leading risk factor for stroke in this country.

A brain aneurysm is a bubble bulging out from the weak wall of an artery in the brain. Most people have no symptoms. Others develop headaches and changes in vision and speech. But the majority of people don't even know they have an aneurysm until it is picked up during a test for an unrelated condition.

The problem is that sometimes aneurysms burst, causing bleeding in the brain - what's known as a hemorrhagic, or bleeding, stroke. The result can be brain damage, severe disability or death, depending on how bad the bleeding is and how quickly it is detected and treated.

Doctors have no way of knowing which aneurysms are going to burst. They just know the very presence of one of these bubbles increases the risk of stroke. "It's like a ticking time bomb in the brain, essentially," says Nasser Razack, director of Interventional Neuroradiology at Bayfront Medical Center in St. Petersburg.

Some aneurysms can be treated by filling them with very fine, threadlike metal coils, pushed into the aneurysm from a microcatheter that snakes through blood vessels from the groin to the brain.

Razack says the smaller the aneurysm, the greater the success with coiling. But larger aneurysms, those that are bigger than a dime, have a high rate of recurrence over time. The coils simply can't fill the entire space, so it essentially refills with blood. It has been compared to filling a box with Slinkies.

"That's where Onyx comes into play," Razack says.

Onyx is an ethylene vinyl alcohol copolymer that received FDA approval in late 2007. Outside the body, it's a thick black liquid that pools like ink when squirted from a syringe. But when squirted into saline, each drop turns into a spongy bead the size of a BB. "Once it hits physiologic PH or the blood in the aneurysm, it turns into a solid," Razack says.

More importantly, because it starts out as a liquid, it can fill the aneurysm completely. Coils can fill only about 35 percent of an aneurysm, Razack says. "Onyx fills the aneurysm 100 percent."

Jan Baldwin, 66, of Indian Rocks Beach, developed a sharp, severe pain in her head that, after a year, left her unable to drive or do household chores. She was eventually diagnosed with a large aneurysm in her brain. Because of the severe, unpredictable symptoms, and because it could rupture at any time, Baldwin felt she had no choice but to undergo treatment.

The least appealing option was brain surgery, in which doctors open the skull and clip off the aneurysm at the neck. Coiling was the less-invasive option, but Baldwin didn't like the idea that it might eventually fail and have to be repeated. Her eye doctor suggested she look into the newer Onyx procedure, and Baldwin decided to give it a try.

After the 3 1/2-hour procedure at Bayfront Medical Center in May, Baldwin spent one night in the hospital and was home the next afternoon. The severe head pain is gone, and she's back to entertaining friends and babysitting grandchildren.

"All the fun stuff," she says. "It's been a miracle."

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