Image of Marianne Koester, brain aneurysm patient at EvergreenHealth Neurosurgery in Kirkland, WA

EvergreenHealth Spine & Neurosurgical Care offers life-saving treatments from neurosurgeons using the latest advances in treating neurovascular disorders.

When Sultan resident Marianne Koester suddenly experienced strange stroke-like symptoms—slurred speech, a headache, nausea, and even a fainting episode—the 64-year-old quickly went home to rest.

Fearing for the worst, her daughter immediately drove her to the emergency department at EvergreenHealth Monroe.

A CT scan showed signs not of a stroke, but of a brain aneurysm, which can occur when blood vessels become enlarged like a balloon, posing serious health risks, especially if they rupture.

The team in Monroe referred Koester to EvergreenHealth neurosurgeon Dr. Emun Abdu to evaluate the severity of the aneurysm and recommend immediate treatment. A diagnostic angiogram revealed a far more serious prognosis: not one, but four aneurysms in Marianne’s brain.

“Marianne’s tests revealed that she had several aneurysms, including one that was quite large and irregularly shaped, putting her at significant risk for rupture. Brain aneurysms can be life-threatening if they rupture, and that risk is correlated to the size, shape and location of the aneurysm. The bigger the artery gets, the thinner its wall becomes and the greater chance it has of bursting,” Dr. Abdu described.

She added: “Marianne’s aneurysms were deemed high-risk: if they ruptured it could lead to bleeding in or around the brain, which in turn could cause other complications, such as delayed stroke.”


Dr. Abdu is one of few specialists in the nation dually trained in both minimally invasive and open cerebral vascular surgery. She counseled Marianne through the benefits and risks of the surgical options available to her.

“I was scared when I heard the news,” Marianne recalled. “But at the same time, I was so grateful that I had found Dr. Abdu. She was very upfront with me, sharing all the details of each treatment option. I felt extremely well taken-care of.”

The pair talked extensively about open brain surgery and minimally invasive endovascular treatment options, of which there are several. Together, they decided on a minimally invasive procedure, performed on a biplane unit, to implant a pipeline embolization device (PED) inside the affected arteries, as it could use a single device to treat all four aneurysms.

A PED is a wire mesh stent that reroutes the blood to flow past the aneurysm, rather than into it. Over time, the aneurysm is deprived of blood supply and shrinks, ultimately disappearing.

“Because of EvergreenHealth and its expert neurosurgeons, what could have been an awful thing turned into a really positive experience,” Marianne said.