Barbara Simons, Aneurysm Coiling

Barbara Simons has only a vague memory of the accident.

She was crossing a five-lane street in Ludington last August 18 at about 11:30 p.m. after she and husband Jim had stopped across the street from a small store to purchase food supplies for their mobile home.

"The street was not busy," Simons said. "I remember looking both ways after leaving the store and stopping in the middle lane to look both ways again."

She remembers a car some distance away, stopped at a traffic signal.

Just as she finished crossing the street, however, a car struck her leg, spinning her around. Her last memory is her head striking the car's outside mirror.

"I was told that the force threw me about 30 feet," said Simons, a 61-year-old Richland resident. "I don't remember ever seeing headlights."

Rushed to a Ludington hospital, Simons underwent a CT exam that showed there was no internal bleeding nor any broken bones. She had stitches in her leg and head and was told by doctors that she was in "no imminent danger."

Simons was discharged from the hospital and she and her family remained in Ludington for three days before heading back to Richland.

Over the next two months, Simons—who, like Jim, is retired—had occasional dizzy spells and "excruciating" headaches.

In October, Sandra DeJong, a nurse practitioner at Borgess’ ProMed Physicians in Richland, recommended that Simons have an MRI to see if there was a physical basis for the persistent problems.

"A couple of days after the MRI a doctor called and said that I had four aneurysms in my brain," Simons said.

An aneurysm is a weak spot in a blood vessel that usually shows up as a bulge. If one of the weak spots were to burst, it could have caused a potentially fatal bleeding stroke. About 20% of all strokes are the result of a bleeding vessel.

When she heard the news, "I thought I was done for," Simons said.

On November 5, Simons had an MRA—an angiogram—done not with X-rays, but rather while the patient is in an MRI machine. It revealed that Simons had five aneurysms, not four.

She made an appointment with a neurosurgeon with from Neurosurgery of Kalamazoo, a practice based on the Borgess campus. The doctor suggested that instead of a highly invasive brain surgery to repair the aneurysms that she consider having a less invasive procedure that uses a catheter to deliver tiny platinum coils to seal them off.

He told Simons that Borgess had a specialist, Dr. Firas Al-Ali, and a close-knit OR team skilled in providing the delicate procedure, called minimally invasive interventional coiling treatment, or simply endovascular coiling.

Dr. Al-Ali, of Neurosurgery of Kalamazoo, is one of the few physicians in the region who treats aneurysms with coils both before and while they are bleeding. He has done hundreds of the procedures.

Al-Ali told Simons that in the procedure, she would be anesthetized while he inserted a thin catheter through a tiny incision in her groin. Guided by X-ray video images, he would feed it through her arterial system to her brain.

Once in place, Al-Ali would put the tip of the catheter at the precise spots where there were aneurysms.

He would then feed tiny, soft platinum wires into the aneurysms, which, on contact with the vessel wall, would begin to coil. Slowly and carefully, he would feed in more wire until the aneurysms were filled.

Once the coils were in the aneurysms, blood platelets would begin to stick to the coils, and clots or scabs would form. In time, the inner layer of the artery would begin to heal, or grow over the now clotted aneurysms.

Simons agreed to the endovascular coiling, in part because she didn't particularly want brain surgery, but also because Al-Ali exuded confidence.

"The first time I saw Dr. Al-Ali I fell in love with him," she said. "That whole team is just amazing."

Still, any brain procedure is worrisome. "I was terrified—though that's not a strong enough word," she said. "But Dr. Al-Ali made me feel more comfortable."

Simons had three coiling procedures over about a month to seal the five aneurysms. Al-Ali also put in three stents to prop open brain arteries.

"This is a woman who is lucky enough to have five aneurysms without one of them rupturing," Al-Ali said. "Only 5% of all people have cranial aneurysms and the vast majority have only one. And in nearly all the people with five aneurysms, the aneurysms aren't discovered until after one bursts."

Al-Ali said that the five in Simons' brain were scattered over a wide area. If she had opted for brain surgery to have them repaired, it would have required two separate surgeries, one on each side of her head. She would have had one surgery and then have had to wait while she recovered enough to undergo the second procedure.

Simons said a week after the second coiling procedure that the headaches and dizziness were gone and that she was slowly gaining back her strength. "I feel good now," she said.

Al-Ali said that the aneurysms existed before the accident. And while the accident very likely made them worse, he said, they may not have been discovered—and could possibly have ruptured at some future date—if Simons had not been hit by the car.

Citing an Arab proverb, he said that some bad things have good results.

"She was unhappy to have had the accident, but she was happy that the aneurysms were found," he said.

"I don't know how to express how I feel about Dr. Al-Ali and the work he and his team do" Simons said. "Jim said he is like an artist. We can't say enough good things about him and his team and all the people at Borgess. We're blessed to have them.”

"I know that Dr. Al-Ali was put here for a reason. He has saved so many people who felt like I did--that we were doomed."

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