A brain, or cerebral, aneurysm is a weakened area in the wall of an artery that supplies blood to the brain. This weak spot balloons outward and fills with blood. As it enlarges, it usually grows silently and most people have no idea that they are harboring an aneurysm. In a few selected instances, it can put pressure on areas of surrounding brain tissue, causing symptoms such as headaches and vision or neurological issues. Aneurysms can also rupture, causing hemorrhaging in the brain and life-threatening strokes.
A number of options for treating a cerebral aneurysm are available, and one of the newer options is coiling – an endovascular procedure with a relatively short recovery time. Brain aneurysm treatment with coiling is not right for everyone, but this minimally invasive procedure can exclude the aneurysm from the brain’s blood flow and reduce the risk of a rupture.
What Is Endovascular Coiling?
Unlike surgical procedures that require opening the skull to access an aneurysm, endovascular coiling is done through the vascular system with just one incision, usually in the large femoral artery in the groin. With the aid of constant X-ray imaging and contrast dyes, your surgeon threads a catheter through the artery until it reaches the aneurysm. Once that catheter is in place at the aneurysm site, your doctor then threads a microcatheter through it to the same location.
Through the microcatheter, a series of tiny, soft, platinum coils are inserted directly into the aneurysm where it balloons out from the main artery. Coils are inserted one at a time until the aneurysm is filled. Once all the coils are placed, they compact to form a tiny metal ball that blocks blood from flowing from the main artery into the aneurysm. Because this procedure encourages blood to flow normally through the artery, rather than into the aneurysm, it can prevent the risk of rupture and stroke. Coiling can also be done to treat an aneurysm that has already ruptured to prevent further bleeding.
Aneurysms are frequently attached to the main artery by a narrow “neck” that gives them a berry-like appearance. But some have wider necks, and in those cases, your doctor may need to add supporting devices, such as a balloon or metal stent (a tiny metal tube with holes in it), to keep the coils in place and make sure blood can flow normally through the affected artery.
Preparing for a Coiling Procedure
Aneurysm coiling is performed in a hospital setting, typically under general anesthesia, to keep patients comfortable and prevent movement. Preparations for the procedure generally begin several days in advance.
In the week or so before your coiling procedure is scheduled, you can expect to meet with your doctors for a series of tests, including a general blood panel and imaging tests such as an MRI or MRA, or CT or CTA scan. A MRA or CTA study evaluates specifically the blood vessels as opposed to the brain itself. Someone times both studies are needed to understand the relationship of the blood vessel to various brain structures. At this time, your doctor will explain the procedure and discuss any issues related to your individual circumstances with you.
Your doctors will want to know what medications you take, including vitamins and supplements. Be sure to discuss them all. You may be asked to stop taking certain medications or adjust your dose in the days before and after your procedure, and your doctor may prescribe new ones.
Be sure to let your doctors know about any allergies you may have to anesthesia or medications, especially allergies to contrast dyes of the kind used in a coiling procedure. These can cause severe reactions, especially if you have kidney problems. Your doctors will provide a detailed list of instructions on how to prepare for the procedure, including any restrictions on eating and drinking on the day of the procedure.
Without complications, a coiling procedure for an unruptured aneurysm typically takes an hour and a half to three hours. After the coils are placed, your doctor removes the catheters and the incision in your groin is closed and sealed. After these steps, you can be moved to a recovery room.
You can expect to remain in the hospital for a day or two while staff monitors your recovery from anesthesia and observes you for any adverse effects from the procedure. If coiling is performed to treat a ruptured aneurysm, recovery in the hospital can take a week or more and might require spending the first few days in an intensive care unit, especially if the rupture caused neurological deficits.
Recovering from Brain Aneurysm Coiling
Without complications, complete recovery from an elective aneurysm coiling procedure typically takes about a week. During that time, you can expect to be restricted from activities such as driving, exercise, lifting or straining or doing strenuous chores. You will also need to keep your incision site clean and dry and avoid bathing and swimming as you recover. You can gradually resume normal activity levels as you feel comfortable and can return to work or school a week or so after the procedure unless your doctor has other instructions.
In the days and weeks after the coiling procedure, you will see your doctors for follow-ups to monitor your progress and check for any neurological issues. You can also expect to have additional MRI or CT scans to check the placement of the coils.
Generally safe and minimally invasive brain aneurysm treatment with coiling can completely resolve an unruptured aneurysm in a large percentage of patients. Knowing how the coiling procedure works can make it easier to plan for your recovery and return to everyday life.
