Monday, September 27,
By Ken Ige,
Three different GDC coils, the type that were used
for Mutsumi Komo's
aneurism to prevent it from rupturing.
Now used at Queen's and
Kaiser, the device worked
wonders for a Kona woman
has helped state care
By Helen Altonn
Two days after suffering an agonizing headache, a Kona
woman was in a Honolulu hospital
getting tiny, hairlike platinum coils implanted in
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
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
The coil can be withdrawn and repositioned as needed.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
By Ken Ige, Star-Bulletin
Dr. Felix Lee Song talks with Mutsumi Komo about
her angiograms. On Sept. 1, Mutsumi had a bad
that wouldn't go away. She went to the doctor and eventually
found out she had an aneurism. Dr. Song used a new
technique to prevent the aneurism from bursting.
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
"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
"The ones who do best with coils are the ones who do best in
surgery," said Calvin Kam, a Honolulu
"It's a hard matter to resolve. They have to know the risks of
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
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,
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
Mutsumi Komo, released
from the hospital Sept. 13, said her tailbone was sore from lying down so
"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.
state health care
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.
Robinson 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,"
"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
1999 Honolulu Star-Bulletin