There are several advanced treatment options for life-threatening brain tumors, aneurysms and strokes. Coiling is a less-invasive procedure that is safer than traditional surgical options and can offer patients immediate pain relief and less recovery time.
What is Aneurysm Coiling?
A neurointerventional physician in Neurointerventional Radiology 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. The doctor inserts 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. The physician chooses the coils’ sizes according to the shape and size of the bleed. This procedure is intricate and requires years of specialized training.
A neurointerventional radiologist 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.”
A 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 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.
This is a good treatment for 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 part of the brain is severely reduced or stops. 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 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:
- Ruptured aneurysms burst open and release blood into the space between the brain and skull, a condition called a subarachnoid hemorrhage (SAH). The risk of repeated bleeding is 35 percent within 14 days after the first bleed. Timing of treatment is important, and needs to be done 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.
- 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 perecent per year but may be higher or lower depending on the size and location of the aneurysm. When rupture occurs, the risk of death is 40 percent, and the risk of disability is 80 percent.
The Surgical Decision
The treatment decision for observation, surgical clipping, bypass, or endovascular coiling depends on the aneurysm’s size, location, and neck geometry. The less invasive nature of coiling is likely to be used in patients who are older, in poor health, have serious medical conditions, or have aneurysms in certain locations. In patients younger than 40, the difference in the safety between coiling versus clipping is small, so the better long-term protection from bleeding may give patients with clipped aneurysms an advantage in life expectancy.