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The entire medical world talks about Marcin and Maciej Misia from Wrocław. The men operated – with the method they developed – a 34-year-old man with a brain aneurysm, which, according to other doctors, was impossible to move. – We drew this aneurysm considering the various possibilities. It was then that we received a new stent model. Suddenly it sparked, we came up with the idea to modify the stent – says Dr. Marcin Miś in an interview with MedTvoiLokony.
Iwona Dudzik, MedTvoiLokony: An aneurysm is like a delayed fire bomb that everyone can have in their head and not know about it. How did your patient find out about his aneurysm?
Dr Marcin Miś: A 34-year-old man had been diagnosed with an aneurysm several years earlier. Usually, when aneurysms are not large, they do not put pressure on the brain and are asymptomatic until rupture. They can be detected accidentally during the diagnosis of other ailments. This patient, however, complained of dizziness and fainting. He had a CT scan and was found to have a brain aneurysm.
The patient found out that he had an aneurysm, but also that the operation would not be possible. Why?
The structure of the aneurysm was extremely complicated, as three vessels emerged from it. Rarely there is one artery departing from the aneurysm sac, let alone three. It seemed impossible to surgically insert the vascular clips in such a way that the blood would continue to flow through the three vessels while the aneurysm was removed from the circulation.
In interventional neuroradiology centers where the patient was consulted, there was no idea for an endovascular procedure, i.e. without opening the skull, so he was disqualified. In Poland, we have over a dozen very good endovascular centers, where eminent specialists in interventional neuroradiology work, for example in Szczecin, Warsaw, Poznań, Katowice, Lublin or Kraków. Doctors in these centers perform even more complex operations on the cerebral vessels. It is possible that the patient would have obtained help using a different technique there, but he did not end up in these centers.
Together with his brother, a neurosurgeon, Dr. Maciej Misie, you undertook a pioneering operation. What was it about?
The patient was young, and my brother and I still wanted to help him. We drew this aneurysm considering the various options. It was then that we received a new stent model. Suddenly it sparked, we came up with the idea to modify the stent. We cut a hole with a scalpel, put the second stent through it, and thus constructed a new type of scaffolding for the vessels. We were not entirely sure if the whole thing would be stable, how the body would react, but we had no other choice. We had to try.
Was the operation itself difficult?
It required the use of more equipment, stents and, additionally, a remodeling balloon. It was a bit more complicated than standard aneurysm embolization.
The procedure itself was correct, it took just over two hours. When the patient woke up and we did a neurological examination, he was fine. After a few days, the patient went home. He was pleased because the previous dizziness, according to his report, was gone.
What was the patient’s perspective if there was no surgery?
You never know when an aneurysm will rupture: today, tomorrow, in a year or ten. We always try to estimate the risk based on the size and shape of the aneurysm, but we are never sure.
In our patient, the aneurysm was very large, over a centimeter long. It would get bigger and eventually it would have to burst. We do not know whether the man would have been 35 or 40 then.
What are the conditions for an aneurysm rupture?
This usually happens with high blood pressure, the blood hitting the wall of the aneurysm with the greatest strength and greater than its strength. More cases of subarachnoid hemorrhages from aneurysms are observed in the winter-spring and autumn-winter periods, with changes in atmospheric pressure.
It is rare in medicine that doctors share a brotherly bond. Is it possible to achieve more in such a tandem, or are there also disadvantages of such cooperation?
My brother was the first to become a neurosurgeon, he started to perform endovascular procedures and he infected me with his passion. We are working together now and it is so that I can trust my brother and my brother can trust me. We don’t have to talk for a long time to understand each other, we know our every step during the procedure.
There are also differences. The brother has more clinical experience with patients. I, on the other hand, know about imaging diagnostics. That is why we complement each other by performing endovascular procedures together. The downside of this cooperation is the fact that we can never go on vacation together, because there is always someone to stay there.
The method has already been baptized by the gentlemen of the name “Teddy Bear Technique”. Will it be hope for more patients who have not been helped so far?
This name came about when a representative and engineer from the company that produced the stent explained to his foreign headquarters that the equipment had unexpectedly become part of a pioneering method. He translated our name into English and it stayed that way. Colleagues from many countries got interested in the method. We did not make any noise about it, so we were surprised by the scale of the positive reaction of the environment. In a slightly simplified version, the method was already used by prof. Hans Henkes from Stuttgart with his patient, for whom he had no idea before. We hope that «Teddy Bear Technique» will help new patients with complex aneurysms.
The NHF finances such operations?
Yes, but the amount of the refund depends on the complexity of the procedure. However, even the highest rates will not cover the costs of our surgery and the hospital has to contribute money. In addition to the valuation of treatments, however, we are worried that the number of treatments is limited, in our hospital we can perform about 30 treatments a year. This is a drop in the ocean of needs, because hundreds of people are waiting for aneurysm surgery.
Brothers Maciej and Marcin Miś (right) with a patient