Treating aneurysms (weakened spots on artery walls) in the brain is challenging. It requires special equipment that is available at Johnston-Willis Hospital Neurovascular Center (a Comprehensive Stroke Center).
The standard treatment for most ruptured aneurysms, as well as many unruptured aneurysms, is a minimally invasive technique called endovascular coil embolization (and variants described below). For most patients, it has replaced surgical clipping, a procedure in which a neurosurgeon cuts a hole in your head finds the aneurysm, and places a metal “clip” at the neck of the aneurysm. Major surgery is not required for aneurysm coiling. The coil(s) are carefully placed within the aneurysm so that they fill the aneurysm and prevent blood from flowing into it to reduce or eliminate the chance it will burst—a potentially life threatening event.
Our goal is to completely fill the aneurysm. However, in some cases, we can’t do this initially and must first stabilize the aneurysm and then follow up with a second procedure to treat it. On rare occasions, we can only fix the aneurysm by closing off the blood vessel that goes to and from it (aneurysm trapping and vascular sacrifice). There are patients who have aneurysms that we must treat surgically with a clip.
Some aneurysms in the brain are particularly complex due to their shape, or geometry, and cannot be completely eliminated. An aneurysm with a wide opening from the blood vessel to the aneurysm bulge (a wide-neck aneurysm) may not hold the coil in place. If the coil doesn’t stay in place, it can “fall out” into the blood vessel and block blood flow causing a stroke. In these cases, we may first insert a stent inside the blood vessel where the aneurysm is located. A stent is a small, wire mesh tube. In a coil embolization procedure for a wide-neck aneurysm, the stent is placed across the aneurysm neck so it extends past the opening on both sides. This helps support the blood vessel and hold the coils in place. This procedure is typically not used in cases where an aneurysm has already ruptured.
Dr. Spinos or your neuroinerventionalist perform many endovascular aneurysm repair procedures and use multiple different stents and different techniques to accomplish this depending on aneurysm and blood vessel anatomy. These include, Neuroform intracranial Microdelivery Stent, the LVIS stent, the Enterprise stent, the Pipeline Embolization Device, the FRED device as well as the WEB device at the Neurovascular center of the JW Neuroscience Center.
Stents are not always required to treat brain aneurysms. We can also use other techniques, such as balloon assisted coiling, double microcatheter technique, and flow diversion. Although your physician will often discuss these options with you before the procedure, sometimes the technique has to be modified during the procedure itself to best treat the aneurysm. Your neurovascular specialist will try to advise you what is best to treat your brain aneurysm. Management of an aneurysm is quite complex, so you will likely spend a significant amount of time discussing the various options with your neurointerventionalist.
What happens during Brain Aneurysm Coiling or Neuroform intracranial Microdelivery Stent and Endovascular Coiling procedure?
Before the procedure, you will have met with Dr. Spinos or your neurointerventionalist in an office visit and discussed the procedure and its risks and benefits.
Prior to your procedure, we’ll take you to a preparation area where our nurses will start an IV in your arm and give you any medication that may be required prior to your procedure. We may give you medicines to protect your kidneys, antibiotics to help prevent infection, and anti-nausea medications. You may have a Foley catheter (tube) placed into your bladder.
We’ll take you to a special room similar to an operating room. This procedure is always done with general anesthesia. You will lie on your back on a table and we’ll clean the area where the catheter (a thin, hollow tube) will enter your body using a special solution to minimize infection. We’ll place sterile drapes over your body and apply a local anesthetic so you don’t feel any pain.
Dr. Spinos or your neurointerventionalist will make a small incision in your upper thigh to insert the catheter. After entering the blood vessels and placing special catheters, he will conduct an angiogram to study the aneurysm and the blood vessels around it (this may be done separately prior to the coiling procedure). You may receive some blood thinning agents during this part of the procedure to prevent a stroke.
If a stent is being used, we will first deliver the stent to the aneurysm. Once the stent is open and in place, Dr. Spinos will deliver one or more spring-shaped, platinum coils into the aneurysm. In most cases, a stent is not used, but the aneurysm is simply filled with these special soft platinum coils. Dr. Spinos will start with larger coils and place progressively smaller coils until the aneurysm is completely filled and blood can no longer enter the aneurysm.
At the end of the procedure, Dr. Spinos or your neurointerventionalist will withdraw the catheter and place a special device in the blood vessel to stop the blood from leaking out. Finally, we’ll put a bandage over the incision. You will go to the anesthesia recovery room and typically to the Intensive Care Unit for at least one night.
After your procedure, your neurointerventionalist will discuss the results of your aneurysm coil embolization with you and your physician. He will see you back in the office regularly over many years to make sure the aneurysm remains well treated.