UM Neurologist Uses New Flow-Diversion Stent Surgery to Close Dangerous Aneurysms for Peruvian Executive

When German Gallo, a 42-year-old businessman in Lima, Peru, started having episodes of double vision and a feeling of pressure in his skull last year, he quickly went to his local doctor. A series of brain scans found three large sausage-shaped aneurysms — one behind the other — in his right carotid artery where it enters the brain.

Dileep Yavagal, M.D., left, with German Gallo.

Because those weak and bulging areas in the artery that carries blood directly to the brain can lead to a dangerous stroke, Gallo was seen in Peru by an interventional neuroradiologist, who tried but failed to insert a flow-diversion stent. A second attempt with an interventionalist in Argentina had to be aborted after an eight-hour surgery, and Gallo was told that his aneurysms were too complicated to treat.

With few options, Gallo set out on a yearlong journey for treatment that would eventually take him to specialists in Chile, a community hospital in South Florida, and as far as Germany, but each attempt was unsuccessful.

Gallo’s physician in Lima then thought to refer Gallo to the University of Miami Health System after remembering a lecture by Dileep Yavagal, M.D., an interventional neurologist at the University of Miami Miller School of Medicine.

“I chose to come to the UM program because of my confidence in Dr. Yavagal’s diagnostic and treatment skills, and the support of the International Medicine Institute made the process move smoothly and rapidly,” said Gallo.

After examining Gallo, Yavagal saw that the aneurysms were located at the front of the skull cavity, putting pressure on the nerves that go to the eyes.

“With the size of these aneurysms, sooner or later the nerves to his eyes were going to be affected,” said Yavagal, noting that Gallo also faced the risk of bleeding on the brain. “If left untreated, the condition can be pretty disabling and even fatal if there were bleeding on the brain.”

Yavagal used a new stent procedure called a flow-diversion Pipeline™ device to successfully treat Gallo. The innovative procedure approved by the U.S. Food and Drug Administration is used for uncoilable and large aneurysms, said Yavagal, a professor of clinical neurology and neurosurgery, chief of interventional neurology, and co-director of endovascular neurological surgery.

Left panel is before, center panel is the flow-diverter stent construct, right panel is three months after treatment.

The device is a tube with a tight mesh-like wall that diverts the blood from flowing outside the stent into the aneurysm and keeps it inside the stent. Yavagal said flow diversion is an important advance in the endovascular management of intracranial aneurysms.

“This leads to a gradual clot formation in the brain aneurysm that is outside the stent and finally a complete shutdown of the aneurysm,” said Yavagal. “These flow diverters are particularly important in treating irregularly shaped aneurysms when standard mesh coils don’t sit well in the blood vessel. Clinical trials have shown that these flow-diversion stents can close 95 percent of aneurysms in six months.”

Because of the complex nature and irregular shape of Gallo’s aneurysms, Yavagal also asked Peter K. Nelson, M.D., professor at New York University and inventor of the Pipeline flow-diversion stent, to observe the procedure in October at UM/Jackson Memorial Hospital. Yavagal used microcatheter techniques to implant multiple flow-diversion stents to cover all three aneurysms without any problems.

When Gallo had his three-month follow-up visit, which included an angiogram, Yavagal found that all three aneurysms had closed completely.

“I was a bit stressed until I saw the results of my angiogram,” Gallo said. “Since then, everything has been great. Dr. Yavagal was very accurate in diagnosing and treating my problem.”

The success of Gallo’s case is due not only to Yavagal’s expertise in aneurysms and training on the Pipeline device but also to the University of Miami Health System’s outreach to Peru through its UHealth International program with the International Medicine Institute, which promotes innovative medicine in the hemisphere and globally through educational and research programs.

Gallo’s physician learned about UHealth’s breakthrough medicine at a presentation by Yavagal at a neuroscience conference in Peru.

These educational forums create relationships that build bridges on multiple levels, which in this case furthered UHealth’s mission of extending patient access to critically needed care.

“Educating international physicians and specialists on the high level and complex care we provide is critical,” said Yavagal. “Regardless of where people live, they should have access to the best care possible.”

For more information on the interventional neurology program at the University of Miami, please call 305-355-1103. International patients should call 305-243-9100.