�������

On the evening of March 9, 2022, Susan Joseph was walking to her car after a meeting in Brooklyn when she was struck by the most intense headache of her life. “It was like a thunderclap,” she says. “I thought my head was about to explode.” The pain was terrifyingly familiar, however: a decade earlier, she’d felt something similar when a ruptured cerebral aneurysm nearly killed her. As she clutched her skull, a coworker asked if he should call for an ambulance. Joseph, a supervisor for an inventory firm, managed to say “Yes, please,” before blacking out.

The 51-year-old was rushed to a nearby hospital, where a CT scan showed a subarachnoid hemorrhage—bleeding around the brain. Unable to provide the specialized care Joseph needed, doctors transferred her to �����о��� Langone Hospital—Brooklyn, a Level 1 stroke center that often accepts patients from neighboring hospitals, and for good reason. �����о��� Langone Health’s has ranked No. 1 in the country on U.S. News & World Report’s Best Hospitals Honor Roll for three straight years. Completing more than 6,000 neurosurgical cases each year, �����о��� Langone has a mortality rate of less than 0.1 percent for cranial procedures, the nation’s lowest.

A CT angiogram, which produces detailed images of blood vessels, revealed that the source of Joseph’s hemorrhage was another ruptured aneurysm. A cerebral aneurysm is a weak spot on an artery in the brain that balloons out and fills with blood. As many as 1 in 50 people have a brain aneurysm. If it bursts, it can cause a hemorrhagic stroke, brain damage, coma, or in about 15,000 cases in the United States each year, death. “About one-third of patients don’t make it to the hospital,” explains Caleb Rutledge, MD, director of vascular neurosurgery at �����о��� Langone Hospital—Brooklyn. “About one-third survive after we treat the aneurysm, but they have significant disability. And about one-third go home with a good outcome.”

Joseph’s rupture was a basilar artery aneurysm, at the base of the brain in front of the brain stem. Fortunately, a temporary clot or platelet plug had stopped the bleeding, but the aneurysm could rebleed at any time. Adding to the complexity of her case, the scan turned up four additional high-risk aneurysms that would also ultimately require intervention.

“Our first goal was to prevent the ruptured aneurysm from rebleeding,” says Dr. Rutledge, who performed a minimally invasive endovascular procedure known as a coil embolization. He inserted a long, thin, hollow tube, or microcatheter, from an artery in Joseph’s arm and guided it into the sac of the aneurysm in the brain. Then, he delivered a set of tiny metal coils through the catheter, plugging the aneurysm.

A coil embolization, however, can provide only a temporary fix for some types of aneurysms, including Joseph’s, which had a wide neck. So after her recovery, Dr. Rutledge planned a second procedure, using an implant designed not just to temporarily plug the aneurysm but to cure it. Known as the pipeline embolization device (PED), it works by redirecting blood flow past the aneurysm through a flexible tube composed of very thin wires braided into a stent. Over time, endothelial cells that line normal blood vessels overgrow and cover the device, permanently healing the diseased blood vessel. The catch was that the PED could not be inserted until the swelling in her brain subsided, and that could take several months. In the meantime, the team could tend to the other aneurysms that needed attention.

Joseph eagerly agreed to the plan. After several weeks in the hospital, she was able to return home. That May, she underwent open brain surgery to have two of her other dangerous aneurysms treated with clips. By August, she was ready for the PED.

Dr. Rutledge had implanted such devices many times since they were first approved by the Food and Drug Administration in 2011. In this case, though, he planned to use a new version (the Vantage PED), just 2.5 millimeters in diameter, delivered with a smaller microcatheter that fits more easily into smaller distal blood vessels—the ones farther from the heart. He asked one of his colleagues, neurointerventionalist Peter K. Nelson, MD, who invented the device, to assist him.

As with a coil embolization, a PED is inserted via an endovascular procedure. On the morning of August 2, both men scrubbed in together, guided the catheter through a puncture in her arm, and used a hair-thin wire to deliver the device across the neck of the aneurysm. Discharged the next day, Joseph was back at work two days after that.

More than two years later, she has fully recovered from the thunderclap that felled her that night, and her aneurysms remain at bay. “You don’t meet many people who have had two subarachnoid hemorrhages,” says Dr. Rutledge, who continues to see Joseph for regular checkups. “It’s like being struck by lightning twice. Susan has been through so much, but she’s so resilient. Her smile lights up the room.”

Joseph confirms that she has plenty to be thankful for these days. Freed from anxiety over the fragile vessels in her brain, she now takes Caribbean cruises, goes dancing on weekends, and relishes playing with her seven grandchildren. “I’m living my best life now,” she says. “Dr. Rutledge is my angel. I am so grateful for that man.”