An aneurysm is the result of a weakness in the wall of a blood vessel. As the blood flow continues to exert pressure on the weakened portion of the wall, a bubble forms and can continue to grow in size. “Picture a bicycle tire where the rubber weakens, and a bulge begins to form; with too much pressure, that bubble bursts. Similar risks are posed for brain aneurysms,” Dr. Gupta explains. In the past, he says, there were two options for treating brain aneurysms: surgical clipping, in which a titanium clip is used to close off the base of the aneurysm and prevent further blood flow into it; and endovascular embolization, a minimally invasive approach that allows the neurosurgeon to access the aneurysm through a small incision in the groin. Small metal coils are then placed in the aneurysm, filling it completely to prevent further blood flow into it, with or without the assistance of a balloon or metal stent. “With both of those methods, you’re only repairing the aneurysm, not the actual blood vessel on which the aneurysm developed,” Dr. Gupta says. New Treatment Methods ow the advent of two new techniques is expanding options and dramatically changing the way neurosurgeons look at aneurysm treatment—and they’re both available at Robert Wood Johnson Medical School and RWJUH. One of these methods involves the use of flow diverters for unruptured cerebral aneurysms. EV3 Covidien’s Pipeline Embolization Device is designed to divert the flow of blood from the aneurysm and back to the natural path of the artery. Pipeline—a braided cylindrical mesh device—is inserted into the area of the blood vessel where the aneurysm is located. Immediately, blood flow to the aneurysm is slowed, and, in conjunction with the body’s natural healing process, the aneurysm shrinks over time, since blood no longer enters it. Pipeline represents a conceptual change in the approach to treating cerebral aneurysms, says Dr. Gupta. He and interventional neuroradiologist Sudipta Roychowdhury, MD, clinical assistant professor of radiology, lead what is considered the most experienced team in the state for this procedure, having performed the highest number of cases in New Jersey, according to the manufacturers of the Pipeline device. “This technology is state-of-the-art and has revolutionized the way we treat brain aneurysms,” says Dr. Gupta. 24 Robert Wood Johnson I MEDICINE dramatically changing the way neurosurgeons look at and treat aneurysms are being implemented by Gaurav Gupta, MD (left), and interventional neuroradiologist Sudipta Roychowdhury, MD (right), clinical assistant professor of radiology, who is leading what is considered the most experienced team in the state for this procedure, having performed the highest number of cases in New Jersey, according to the manufacturers of the Pipeline device. N ew techniques that are