Aneurysm Embolization

General Information | Scheduling, Insurance and Preparation | What to Expect


General information General Information

About Aneurysms

With coil embolization, numerous soft platinum coils are placed into the aneurysm through the catheter.

An aneurysm is an area of weakening and bulging in an artery. Blood vessels in the brain are particularly prone to aneurysm formation. As an aneurysm grows, its potential to cause significant side effects and/or rupture increases. Some patients do not experience any symptoms.

Symptoms of a brain aneurysm may include:

  • Paralysis
  • Headaches
  • Impaired vision
  • Neck and upper back pain
  • Nausea
  • Vomiting

When an aneurysm ruptures, the result may be a life-threatening stroke.

About Aneurysm Embolization

With coil embolization, an interventional neuroradiologist guides a long tube called a catheter through a small incision in the groin up to the location of the aneurysm. Through the catheter, the radiologist places many soft platinum coils into the aneurysm. The coils are extremely small and soft. The body develops a blood clot around the coils. The packed coils and the blood clot effectively prevent blood from entering the aneurysm, essentially eliminating the risk of the aneurysm rupturing.

A stent, which is a small mesh tube, may also be used in this procedure if the neck of the aneurysm is wide. The stent covers the neck of the aneurysm and helps to hold the coils in place. This method of stent placement before coil placement allows for the treatment of certain aneurysms that were previously considered untreatable. In other cases a balloon may temporarily be inflated at the neck of the aneurysm to help hold coils inside the aneurysm.

Aneurysm embolization (coiling) may be performed as a preventive measure in people with an un-ruptured aneurysm. It may also be done in patients whose aneurysm has ruptured. It is frequently an alternative to surgery when surgical treatment is considered high risk.

Aneurysm Embolization versus Surgery

Until recently, surgical clipping was traditionally the method used to repair aneurysms in the brain. With surgical clipping, the skull is cut open and the aneurysm exposed. A clip is then placed at the neck of the aneurysm.

In 1995 the FDA approved the use of coils to embolize (block off) an aneurysm (termed "coiling"). This procedure offers a minimally-invasive method of treating both ruptured and un-ruptured aneurysms.

Not every patient is a suitable candidate for aneurysm embolization. When both treatments are considered reasonable (surgical clipping or coiling), your interventional neuroradiologist and neurosurgeon will discuss your case and determine which treatment is better for you.

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Risks Involved in an Aneurysm Embolization

There are some risks associated with this procedure, similar to those with surgical clipping. Coil embolization of an un-ruptured aneurysm carries less risk than embolization of a ruptured aneurysm. Following are some of the risks:

  • Possible damage to a blood vessel, bruising or bleeding at the puncture site, or infection.
  • Small risk of allergic reaction to the contrast material used during the procedure.
  • Serious complications related to damage of the aneurysm wall. This can result in bleeding or clot formation around the aneurysm coils or on the catheter and cause a blockage of a blood vessel in the brain and possibly stroke. These serious complications, such as stroke or death, are rare (in general about 5% risk).

Scheduling, Insurance and Preparation Scheduling, Insurance and Preparation

Procedure Locations

Consultations for preventative aneurysm embolizations are done at RIA Neurovascular.

The procedure is performed at the following Radiology Imaging Associates partner hospitals in the Denver, Colorado area:

  • Exempla Lutheran Hospital
  • Littleton Adventist Hospital
  • Medical Center of Aurora
  • Swedish Medical Center
Call 720-493-3345 to schedule a consultation.

Scheduling

To schedule a consultation to discuss aneurysm embolization, call 720-493-3345.

Insurance Coverage

Aneurysm embolization is usually covered by insurance. If this procedure is done as a preventive measure, check with your insurance company to be sure.

Conditions to Let Us Know About

When you have your consultation for an aneurysm embolization, let the radiologist or nurse know if any of the following circumstances apply to you:

  • Currently pregnant or nursing
  • Previous reaction to iodine or contrast material
  • Renal disease
  • Asthma with inhaler use 2 times or more per day
  • Diabetic

Preparation Guidelines

If you are a candidate for preventative aneurysm embolization, you will be given detailed preparation guidelines. Following are some of the basic guidelines; however, you may receive additional or differing guidelines based on your specific situation. Please contact us at 720-493-3406 if you have any questions.

  • If a stent will be used, your physician may start you on Plavix and/or aspirin before the procedure (specific instructions will be given)
  • Do not eat or drink anything but clear liquids for 8 hours before the procedure; do not drink anything for 4 hours before the procedure
  • Prepare for an overnight stay in the hospital.
  • Arrange for someone to drive you home from the procedure.

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What to Expect What to Expect

Before the Procedure

If you appear to be a candidate for preventative aneurysm embolization, you will undergo various exams prior to the procedure. These are necessary for the radiologist to confirm the diagnosis and help plan for treatment.

During the Procedure

A fluoroscope allows the radiologist to see the catheter within the blood vessels and carefully guide it to the opening of the aneurysm.

Here is generally what will happen during an aneurysm embolization procedure:

  1. You will change into a gown.
  2. A technologist will answer your questions then start an intravenous (IV) line in your arm. He or she will set up various devices so your heart rate and blood pressure can be monitored throughout the procedure. You will most likely be given general anesthesia and will sleep during the procedure.
  3. The site of the groin incision will be cleansed.
  4. A fluoroscope will be moved into position above the abdomen.
  5. The groin incision will be made and the catheter will be inserted into the femoral artery. Using the fluoroscope images, the radiologist will carefully guide the catheter to the location of the aneurysm.
  6. If a stent is required, it will then be deployed through the catheter and put in place at the aneurysm site.
  7. A micro-catheter will be advanced through the original catheter to the opening of the aneurysm.
  8. A platinum coil will be pushed through the micro-catheter into the aneurysm. The coil will bend and conform to the shape of the aneurysm. After the coil is deposited, if the position is deemed acceptable it is detached. Your physician will insert as many coils as are necessary to completely fill the aneurysm.
  9. The micro-catheter and catheter will be withdrawn and the incision cleaned and taped.
  10. A CT scan or ultrasound will be done so the radiologist can verify that the stent graft is properly placed.

The procedure takes two to four hours to complete, depending on the complexity of the situation. You will then spend several hours in the recovery area. Patients with un-ruptured aneurysms often go home the next day. Patients who’ve had an aneurysm rupture may spend up to two weeks in the hospital.

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After the Procedure

Recovery

After the procedure, patients may experience the following:

  • Mild nausea
  • Headache
  • Mild incision pain

Please contact our office at 720-493-3345 if you experience any neurologic changes, have a fever or other signs of infection, have persistent incision discomfort, or any other concerns.

Follow-Up

It is very important that you go to all follow-up appointments. You will have an angiogram at 6 months and 18 months after the procedure to ensure the aneurysm embolization was successful and the aneurysm has remained blocked. Your neuroradiologist will see you in his office at RIA Endovascular roughly two weeks after the procedure. If you have any questions, you can reach an RIA neuroradiologist at 720-493-3406.

All patients with endovascular coiling will require the following after their procedure:

  • A clinic follow-up at 2 weeks, which can be completed on the phone if you live out of state.
  • A 6 month follow-up angiogram to ensure the aneurysm embolization was successful and the aneurysm remains blocked. Additional angiograms and or imaging may be required at the discretion of the treating physician.

Please call RIA Neurovascular at 720-493-3345 to schedule these appointments.

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