3-D Imaging of the Cerebral Vasculature
Aneurysm Embolization
An aneurysm is the weakening and bulging of a vein or artery. Blood vessels in the brain are susceptible to aneurysms, as are vessels in other areas of the body. As an aneurysm grows, its potential to cause significant side effects and/or rupture increases. Some of the clinical symptoms of a brain aneurysm may include nerve paralysis, headaches, neck and upper back pain, nausea, and vomiting. When an aneurysm ruptures, the result may be a life-threatening stroke.
Until recently, surgical clipping was traditionally the method for repairing aneurysms in the brain. However, in 1995 the FDA approved the use of coils to embolize an aneurysm (termed “coiling”). This procedure offers a minimally-invasive method of treating both ruptured and un-ruptured aneurysms.
With coil embolization, an interventional neuroradiologist threads a a catheter, through a small incision in the groin to the site of the aneurysm. Through the catheter, the physician places numerous soft platinum coils, narrower than a human hair, into the aneurysm. 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, 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 keep the coils in place. This method of stent placement prior to coil placement has allowed for treatment of certain aneurysms that were previously considered untreatable.
Aneurysm coiling is most often performed under general anesthesia, but local anesthesia can be used also. Results of this procedure have been promising with long-term follow-up showing permanent success in more than 80% of cases. This is a comparable success rate to surgical clipping.
This page contains the following information about aneurysm embolization:
- Reasons for Having Aneurysm Embolization
- Risks Involved in Aneurysm Embolization
- Conditions to Let Your Doctor Know About
- Insurance Coverage for Aneurysm Embolization
- Procedure Locations
- Scheduling an Aneurysm Embolization
- Preparing for an Aneurysm Embolization
- What to Expect During Your Procedure
- Recovering from Your Procedure
- Follow-Up for This Procedure
- Watch a Video of This Procedure
- Additional Information
Reasons for Having Aneurysm Embolization
Aneurysm embolization may be performed as a preventive measure in people with an un-ruptured aneurysm, or in patients who have experienced rupture of the aneurysm. It is frequently an alternative to surgery when surgical treatment is considered extremely high risk.
Not every patient is a suitable candidate for aneurysm embolization. When both treatments are considered reasonable (surgical clipping or coiling), there are certain factors that would favor endovascular coiling:
- Patient can’t or doesn’t want to receive a blood transfusion, which may be necessary during surgery.
- Patient can’t receive general anesthesia.
- There is a significantly shorter recovery period.
- There are fewer potential complications.
Risks Involved in Aneurysm Embolization
Obviously 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 an acutely ruptured aneurysm.
During catheter placement within the blood vessels, there is a risk of damage to a blood vessel, bruising or bleeding at the puncture site, or infection.
Rarely, patients may experience an allergic reaction to the contrast material used during the procedure.
There is a possibility that the coil and blood clot won’t adequately prevent blood flow into the aneurysm. In some cases, repeating this procedure will achieve complete obstruction.
You could experience stroke-like symptoms after the procedure, such as weakness in a limb, numbness, tingling, speech disturbances and visual problems.
Serious complications such as permanent stroke or death are rare.
Conditions to Let Our Doctor Know About
In advance of your exam, let your INVISION radiologist or technologist 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
Insurance Coverage for Aneurysm Embolization
Aneurysm embolization is covered by many insurance carriers. If this procedure is done as a preventive measure, check with your insurance carrier to be sure.
Procedure Locations
Aneurysm embolization is performed by INVISION radiologists at the following INVISION partner hospitals in the Denver, Colorado area:
- Medical Center of Aurora
- Littleton Adventist Hospital
- Porter Adventist Hospital
- Sky Ridge Medical Center
- Swedish Medical Center
Consultations for aneurysm embolization are done at the INVISION Vascular and Interventional Clinic.
Please note:
INVISION is partially owned by Radiology Imaging Associates (RIA); consequently, your radiologist’s lab coat and your bill, if you receive one, may say RIA rather than INVISION.
Scheduling an Aneurysm Embolization
To schedule a consultation for a aneurysm embolization, call 720-493-3406.
Preparing for an Aneurysm Embolization
Following are the preparation guidelines for aneurysm embolization. Please contact us at 720-493-3406 if you have any questions.
- If a stent will be used, take Plavix and aspirin for 7 days 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.
What to Expect During Your Procedure
If you appear to be a candidate for elective aneurysm embolization, you will undergo various exams including a blood test and imaging exams, such as CT scan, CT angiography, MRI, or MR angiography. These exams will help the radiologist confirm your eligibility for aneurysm embolization and plan treatment.
When you come in for the procedure, you will be asked to change into a gown. After answering any questions you have, a technologist will 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 may be given conscious sedation for the procedure, but it is more likely you will be given general anesthesia and will sleep during the procedure.
A fluoroscope is used during aneurysm embolization to allow the radiologist to see the movement of the catheter within the body and brain. The fluoroscope will be moved into position over the abdomen.
After injecting local anesthetic and making a small incision at the groin, the radiologist will thread a small catheter into the femoral artery. While watching the fluoroscope images on a computer screen, the radiologist will maneuver the catheter through the arteries until it is near the brain aneurysm. At this point, a micro-catheter (a very tiny tube) will be advanced through the original catheter to the opening of the aneurysm. 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, a very small electric current is applied to the wire to make it detach from the micro-catheter. The radiologist will insert as many coils as are necessary to completely fill the aneurysm.
If the neck of the aneurysm is wide enough to require a stent, the stent will be deployed through the catheter first. After the stent is in place, the coils will be deposited in the aneurysm through the stent.
After the aneurysm is completely filled, the micro-catheter and catheter will be withdrawn and the incision cleaned and taped.
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 a stroke may spend up to ten days in the hospital.
Recovering from Your Procedure
After the procedure, patients may experience mild nausea and low-grade fever. Patients may also have headaches that last days to months after the procedure.
Patients with an un-ruptured aneurysm typically recover in 24 hours and can resume their normal activities. Recovery time for patients with a ruptured aneurysm is quite variable and depends on many factors, such as the clinical condition of the patient upon arrival to the hospital.
Follow-Up for This Procedure
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.
Watch a Video of This Procedure
The following video, courtesy of Micrus Corporation, show an animation of an aneurysm coil embolization. This video requires Microsoft Media Player.
| File Size | Estimated Download Time (56k modem) |
||
|---|---|---|---|
| Micrus Coiling Video | 9 MB |
22 min. |
The following technical videos, courtesy of Boston Scientific, show an animation of an aneurysm coil embolization and an animation of an embolization with a stent. These videos requires Microsoft Media Player.
| File Size | Estimated Download Time (56k modem) |
||
|---|---|---|---|
| Boston Scientific Coil Embolization | 50 MB |
2 hrs . |
|
| Boston Scientific Coil Embolization with Stent | 15.5 MB |
38 minutes |
Additional Information
The information on this page was taken in part from some of the following web sites. Visit these sites for additional information on aneurysm embolization.
