Pittsburgh, June 30, 2007 -- Earlier this year, Michael Horowitz, MD, chief of neurosurgery and director of the Center for Endovascular and Exovascular Therapy at UPMC Presbyterian, helped lead a team of surgeons and radiologists at University Medical Center at Princeton, NJ, successfully treat an impoverished Ecuadoran national diagnosed with a complex neuroradiology procedure and unable to receive care in his homeland.

William Morocho Japa, 26, of Cuenca, Ecuador, was diagnosed with an intracranial aneurysm—a bulging, weakened wall of an artery that supplies blood to the brain. Although a common ailment, it can be life-threatening and doctors in Ecuador lacked the technology and expertise to treat it.

The Journey

Japa’s ordeal began in October 2006 as the result of a serious motor vehicle accident. After spending 11 days in a coma, he awoke in a hospital bed lucky to be alive. He remained hospitalized for three months. After surgery in Ecuador, physicians discovered the intracranial aneurysm during Japa’s medical evaluation.

Speaking through an interpreter, Japa said, “The doctors told me there was nothing they could do. I was going to be sent home to wait and see what would happen. I became very depressed; I felt hopeless.”

Word of Japa’s potentially life-threatening condition soon spread. Relatives and the Latino community in Hightstown, NJ, learned of it and began a dedicated effort to bring him there for treatment.

Father Miguel Valle, parochial vicar at Saint Anthony of Padua Catholic Church in Hightstown, suggested to Japa’s father-in-law Jose Sergio Naulaguari, that the family get in touch with fellow parishioner David Abalos, PhD. Dr. Abalos called Robbi Alexander, RN, program coordinator of Princeton HealthCare’s Community Education and Outreach Program who in turn contacted Barry S. Rabner, president and CEO of Princeton HealthCare. Rabner took an immediate interest in Japa’s case.

A team of Princeton HealthCare physicians was assembled to help treat Japa, including neurosurgeon Mark R. McLaughlin, MD—a graduate of the University of Pittsburgh neurological surgery residency program—internalist Victor D. Iturbides, MD and Donald F. Denny, MD, chief of radiology at Princeton HealthCare.

Princeton HealthCare and members of Japa’s medical team agreed to wave all costs related to Japa’s care and he was subsequently granted a medical visa to travel to Princeton. By the time he arrived in New Jersey, his aneurysm had doubled in size.

The Treatment

There are two main concerns related to an intracranial aneurysm. First, as an aneurysm gets bigger it places pressure on the nerves around the eye muscles causing eye movement abnormalities, double vision, headache, and facial numbness. This was the case with Japa who experienced all of these symptoms prior to the procedure. The main concern, however, was that the aneurysm could rupture resulting in vision loss or stroke, leading to severe disability.

An endovascular embolization was needed to treat Japa. Due to the complicated nature of this procedure, Dr. McLaughlin enlisted the help of Dr. Horowitz, a longtime friend, mentor and colleague and a world-renown expert in the procedure.

“An endovascular embolization is a minimally invasive catheter-based procedure designed to essentially patch the aneurysm, blocking it off from regular blood flow so it is no longer a problem.” Dr. McLaughlin said in explaining the operation.

“During the procedure, a stunt and coil device is positioned within the aneurysm blocking blood flow and preventing rupture. The platinum coil resembles a miniature slinky that when deployed, is designed to curl around inside of the aneurysm filling and stabilizing it. The material is flexible enough to fit and fill any aneurysm shape. The end result restores normal circulatory patterns alleviating symptoms and risk.”

The neuroradiology procedure used catheters that were guided with real-time X-ray technology, called fluoroscopic imaging. This allowed physicians to see and navigate Japa’s vascular system and treat the aneurysm from inside the actual blood vessel. The procedure took approximately 1.5 hours and physicians knew immediately afterward that it was a success.
According to Dr. McLaughlin, “The procedure was a complete success. By treating William’s aneurysm in this manner we have eliminated all risk of disability that he faced had this not been treated.”

“It was a pleasure helping my colleagues in treating William,” Dr. Horowitz said. “What they’ve managed to do in getting this young man here for treatment is nothing short of extraordinary. It’s a privilege to have been a part of it.”

In addition to services donated by the medical center and medical staff, several medical device companies—including Boston Scientific, ev3, Inc, Cook Medical, Cordis Corporation and Terumo Cardiovascular Systems—donated equipment and technology to Japa’s cause.

Appreciation

Speaking on the treatment that he received, Japa—a devout Catholic—said, “When I learned that there were people, some who are complete strangers, trying to get me to New Jersey for treatment I was completely overwhelmed. I felt incomparable happiness. There are no words to express my gratitude.”

He added, “I am indebted to University Medical Center at Princeton, University of Pittsburgh Medical Center, and Drs. Horowitz, Denny, and McLaughlin for taking care of me and to Mr. Rabner.

Although Japa’s family in Ecuador was not able to travel with him, he spoke with his wife, Francisca Naulaguari Panjon, 26, and daughter, Diana Morocho Japa, 3, every other day. I can’t wait to return to my wife and my family; I miss them so much. That’s what I am looking forward to the most, seeing my wife and daughter. I have faith that God will get me there.” •