Metal coil
strengthens weak
blood vessels
Now used at Queen's and
Kaiser, the device worked
wonders for a Kona womanSpecialist has helped state care By Helen Altonn
Star-BulletinTwo days after suffering an agonizing headache, a Kona woman was in a Honolulu hospital getting tiny, hairlike platinum coils implanted in her head.
They were packed into an aneurysm -- an abnormal bulging of a blood vessel wall -- to prevent it from rupturing.
Mutsumi Komo, 71, was among the first Hawaii patients of Dr. Felix L. Song for a Guglielmi detachable coil. Her headache lingered for several days after the coiling, then disappeared.
A neuro-interventional radiologist, Song was previously at the Mallinckrodt Institute of Radiology in St. Louis. He joined the Queen's Medical Center in late August and also performs coiling at Kaiser Medical Center.
Until he arrived, island patients had to go to the mainland for the procedure or wait for California specialists to visit the two hospitals.
The standard treatment for an aneurysm has been to open the skull and place a metal clip across the aneurysm's neck to prevent arterial blood from flowing into it.
The clip also prevents any clot in the aneurysm from entering the artery and possibly causing a stroke.
The coil performs the same function, but without major surgery.
The procedure was introduced in 1991 for certain inoperable cerebral aneurysms. Now it's "the first line of treatment" in France, and nearly all major medical centers in the United States are offering it, Song said.
This is how it works:
A thin, flexible tube or catheter (about the size of a pencil tip) with the little coil at the end is steered from the groin through an artery to the aneurysm.
The coil can be withdrawn and repositioned as needed. It is detached by electrical current, and other coils can be added to fill up the aneurysm.
Song said coiling can take about six hours.
"We just want to treat the aneurysm and not block off the blood vessel," he said. "We tend to be excruciatingly slow to preserve as much brain function as possible."
The coils stay in place, and follow-up arteriograms are done to determine whether the aneurysm has grown and more coils are needed.
Song said surgery and coiling both entail risks. "Some (aneurysms) are easy to be clipped and should be. Some are difficult and should be coiled."He said the treatment should be decided by the patient, in consultation with an interventional radiologist and neurosurgeon.
Neurosurgeon Bernard Robinson, chief of Kaiser's neuroscience department, agreed that some patients are better treated with surgery and others with coils.
"The reason we all share in decision-making is to try to make sure there is a good match between the patient's preference and professional input so we do what's best overall -- quality as well as preference," Robinson said.
"The ones who do best with coils are the ones who do best in surgery," said Calvin Kam, a Honolulu neurosurgeon.
"It's a hard matter to resolve. They have to know the risks of both."
Komo and her husband, Kenneth, have operated the K. Komo "mom-and-pop" convenience store in Kona for nearly 50 years.
She said she was taking a shower Sept. 1 when she had a terrible headache on the right side. When the usual headache remedies didn't alleviate the pain, she went the next day to her Kona doctor, Bradon Kimura.
Her blood pressure was unusually high and she normally had no headaches, so he sent her to Kona Hospital's emergency room, she said.
After tests showed she had an aneurysm, she was referred to Kam. He called Song, who discussed treatment options and risks with the Komos.
"He showed us an X-ray of the aneurysm and explained the new type of surgery," Kenneth Komo said.
"He was very thorough as to the results: If we don't do surgery or an operation, she might get a stroke; she could die."
There's a 50 percent chance of death and a 25 percent chance of stroke when an aneurysm ruptures, Song explained. The classic symptom, he said, is when a person has "the worst headache" of their life.
Komo's aneurysm hadn't ruptured but had leaked, he said.
The need for treatment is urgent to prevent the body's response to hemorrhage from an aneurysm, he said.
"Arteries in the brain narrow, and that can lead to severe strokes or death."
Mutsumi Komo, released from the hospital Sept. 13, said her tailbone was sore from lying down so long.
"Other than that, I feel fine," she said.
Kam said Komo "came in in pretty good shape."
Others in much worse condition have been treated with coiling "that we're proud of because of all the possible complications," he said.
Dr. Felix L. Song's arrival in Hawaii "overnight has changed our mind-set," said Dr. Bernard Robinson, a neurosurgeon who heads Kaiser Medical Center's neuroscience department. Specialist has
helped improve
state health careRobinson and Steve Holmes, Queen's neuroradiology lab director, convinced Song to come to Hawaii.
Aneurysm patients who previously needed surgery had to go to the mainland for the alternative coiling procedure or sit around and hope something bad didn't happen until a coil specialist came from the mainland, Robinson said.
Song commended Queen's President Art Ushijima and the hospital for investing millions of dollars in an interventional radiology laboratory and equipment "even before they had a person" on staff to do the coiling.
"Having him (Song) here is a real good thing for the community," Robinson said.
"The real big plus here is, we were able to cooperate between institutions and improve the caliber and scope of care for our state."
Robinson praised Queen's neuro intensive care unit -- the only one in the state dedicated to neurology cases -- and the team effort by Song and the unit.
Song said the intensive-care neurologists are "very alert" to complications after surgery or coiling for an aneurysm.
Helen Altonn, Star-Bulletin
