Endovascular Aneurysm Coiling
There are several advanced treatment options for life-threatening brain tumors, aneurysms and strokes. Coiling is a less-invasive procedure that generally is safer than traditional surgical options and can offer patients immediate pain relief and less recovery time.
What is Aneurysm Coiling?
A neurointerventional physician at the University of Tennessee in Knoxville, inserts a 1,500-millimeter micro catheter into the femoral artery in the groin and advances it through many twists and loops of vessels to reach the site of the bleed and insert a coil into an aneurysm that may be only two or three millimeters in size. Once the micro catheter is positioned inside the aneurysm, a series of specifically shaped coils are inserted into the aneurysm to fill it. They physician chooses the coils' sizes according to the shape and size of the bleed. This procedures is highly intricate and requires years of specialized training.
A neurointerventional radiologists can treat a brain aneurysm under the guidance of the biplane system without having to perform an open brain surgery. A brain aneurysm is a serious medical condition where an abnormal, outward swelling of an artery in the brain can rupture, causing a serious stroke or death. Bleeding aneurysms can compress surrounding brain tissue or cranial nerves, which cause many patients to describe it as “the worst headache of my life.”
Rupture can be prevented with a technique called coiling, which closes off the blood flow into the aneurysm by packing it tightly with detachable platinum coils. The doctor uses the X-ray guidance to insert the platinum coils into the aneurysm through a catheter from the groin extending to the brain. This amazing procedure is saving lives and recovery takes only one to two days compared to weeks for the open brain surgery.
One especially important application is for the treatment of strokes, the third leading cause of death in the United States and perhaps the greatest cause of disability. A stroke occurs when a blood vessel is blocked and blood flow to that part of the brain is severely reduced or has stopped. That part of the brain stops functioning and may die if the blood vessel is not reopened.
The neurologists and neuroradiologists at the Brain and Spine Institute can perform several advanced treatments, depending on how much time has passed since the blockage started. Within three hours, a clot-busting drug can be given through a vein. Within six hours, a catheter can be placed into the blocked vessel (like an angiogram) and a clot-busting drug is injected into the clot.
Who is a Candidate?
The choice of aneurysm treatment (observation, surgical clipping or bypass, or endovascular coiling) must be weighed against the risk of rupture and the overall health of the patient.
Coiling may be an effective treatment for the following:
Ruptured aneurysms burst open and release blood into the space between the brain and skull, called a subarachnoid hemorrhage (SAH). The risk of repeated bleeding is 35% within the first 14 days after the first bleed. So timing of treatment is important - usually within 72 hours of the first bleed. Vasospasm (narrowing of an artery) is a common complication of SAH, which must be closely managed after treatment to prevent a stroke (see Subarachnoid Hemorrhage).
Unruptured aneurysms may not cause symptoms and are typically detected during routine testing. People with a family history of brain aneurysms should have a screening test (CT or MR angiogram). The risk of aneurysm rupture is about 1% per year but may be higher or lower depending on the size and location of the aneurysm. However, when rupture occurs, the risk of death is 40%, and the risk of disability is 80%.
The Surgical Decision
The treatment decision for observation, surgical clipping or bypass, or endovascular coiling largely depends on the aneurysm’s size, location, and neck geometry. The less invasive nature of coiling is likely to be favored in patients who are older, are in poor health, have serious medical conditions, or have aneurysms in certain locations. In patients younger than 40 years of age, the difference in the safety between coiling versus clipping is small. Therefore, the better long-term protection from bleeding may give patients with clipped aneurysms an advantage in life expectancy.
Click here to learn more about Interventional Neuroradiology at UT Medical Center.