For 2017, The Bee Foundation awarded our annual brain aneurysm research grant to two researchers – Jennifer Kim, a neurocritical care fellow at Mass General Hospital, and Justin Mascitelli, cerebrovascular fellow at the Barrow Neurological Institute in Phoenix. We spoke with Dr. Mascitelli to learn more about his research project.
Tell us a little about yourself.
I was born and raised in New York City, attended the University of Pennsylvania for undergrad, Weill Cornell for medical school, Mount Sinai for Neurosurgery Residency and Endovascular Fellowship, and am currently at the Barrow Neurological Institute in Phoenix for a Cerebrovascular Fellowship.
Why did you get involved in the field of brain aneurysm research?
I have been interested in vascular neurosurgery since I was an undergraduate at UPenn and have been studying aneurysms since then. I find brain aneurysms very interesting because there are so many different ways to treat them and the field is still rapidly evolving.
What is the name of the research project for which you received the grant?
The name of the project is: A multicenter, prospective registry wide-neck intracranial aneurysms treated by both microsurgical and endovascular techniques.
Can you give us a high-level overview of what you’ll be studying?
The decision to acutely treat a ruptured intracranial aneurysm (IA) with microsurgical clipping (MC) or endovascular therapy (EVT) has been debated for nearly two decades. The International Subarachnoid Aneurysm Trial (ISAT), published in 2002, demonstrated improved mortality and dependency rates at 1-year in those undergoing EVT versus those undergoing MC. The trial had a significant impact on practice patterns in the United States and around the world, with an increase in EVT for ruptured IAs. Narrow neck IAs are straight-forward to treat with stand-alone coiling with low risk. Wide neck IAs, on the other hand, are more difficult to treat with EVT and usually require additional techniques such as balloon-assisted coiling (BAC), stent-assisted coiling (SAC), flow diversion (FD), or the use of emerging technologies such as intrasaccular devices or parent vessel support devices. These additional techniques increase the risk of the thromboembolic complications during the procedure and, in certain cases, require the patient to be on dual anti-platelet therapy during the acute subarachnoid hemorrhage (SAH) period. There is a paucity of literature addressing the topic of ruptured wide neck aneurysms and we believe it would be worthwhile to study the outcomes of each treatment modality. The choice of study methodology, however, is not straightforward. Although, prospective randomized trials are considered the gold standard, they have many drawbacks. Pertinent examples include enrollment bias in ISAT or intent-to-treat analysis with high crossover rates in BRAT. Therefore, we propose a multicenter, prospective registry as a study design with the ability to do propensity score analysis to create equivalent populations to compare.
How will your research impact the landscape of preventive brain aneurysm research?
We will be studying both ruptured and unruptured wide neck aneurysms. Understanding the best treatment for unruptured wide neck aneurysms will help prevent aneurysm rupture in this population.
What are your ideal outcomes?
Ideally we will identify the best treatment for wide neck aneurysms in terms of both clinical and angiographic outcome. But even if we find out there is no difference in treatment, this is an important finding as well and suggests that each individual doctor should provide the treatment that he or she feels is best in his or her hands.
Assuming successful outcomes, what is the next step to advance your research?
The next step would be to apply this study methodology (multicenter registry) to other types of aneurysms and other cerebrovascular pathologies.
Will this research branch out into other areas?
There is no plan for that at this time but we are always open to new ideas.
How would you explain this research study to a friend who does not conduct clinical research?
The purpose of this study is to determine the most effective treatment method for wide neck aneurysms. Aneurysms are outpouchings off the side of blood vessels where the vessel wall has become weak. Wide neck aneurysms have a neck that is relatively wide compared to the aneurysm height. Current treatment options include both open surgical and catheter-based techniques. We hope to determine the best treatment modality of wide neck aneurysms
Are you excited to attend the Honey Bash?
Yes! It’s going to be awesome!
What is one thing you want people to remember about your research?
There is no large study on wide neck aneurysms. I would like this to be the “go-to” study when anyone wants to study and learn about wide neck aneurysms.
In 50 (or so) words or less, what would you like the world to know about brain aneurysms?
Brain aneurysms may be frightening, but we have many excellent treatments and these treatments are only improving. The future of brain aneurysm understanding and treatment is bright.
What needs to be done to better educate people – primary care providers, as well as, those not in the medical field – about the risks and warning signs of brain aneurysms?
Some brain aneurysms may be discovered before they rupture. There are certain features that are considered risky, such as large or enlarging size, irregularity, history of smoking or high blood pressure, and a personal or family history of aneurysm rupture. If these risky features are present, an unruptured aneurysm should be treated. Other brain aneurysms are discovered after they rupture and usually patients experience a so called “worst headache of life.” This is an emergency and these types of aneurysms should be treated immediately.
How can people outside the medical field best support brain aneurysm awareness and research?
Lots of donations!
Take Dr. Mascitelli’s advice and donate today:
Or get your tickets now to the 2017 Honey Bash to support brain aneurysm research & awareness, as well as watch Dr. Mascitelli’s presentation, enjoy a dinner prepared by James Beard Award Winning Chef Jose Garces, participate in a live auction, and more!