If your doctor discovers that you have an aneurysm, he or she may suggest that you undergo a coiling procedure to prevent the affected artery from leaking or bursting. When aneurysms rupture, they can cause health issues including severe headaches, slurred or incomprehensible speech and even death. Typically, you can expect a coiling procedure to take about an hour and a half to three hours.
Coil procedures for brain aneurysms prevent aneurysms from leaking or bursting by filling the artery with small and soft metal coils. Once the aneurysm has been filled, it gets cut off from normal blood flow. As long as blood cannot enter the artery, it will not have a chance to leak or burst.
Doctors perform coiling procedures by making a small incision their patients’ groins. The incision makes it possible for doctors to insert a catheter into the femoral artery. If you undergo this procedure, your neurosurgeon will wind a microcatheter through your blood system to reach the aneurysm. At this point, your doctor can fill the aneurysm with coils and retract the catheter. It’s a minimally invasive procedure that doesn’t usually cause prolonged discomfort.
Preparing for Your Aneurysm Coiling Procedure
Preparations for your coiling procedure begins days before your scheduled surgery day. You can expect to undergo tests, including blood tests, a CT or MRI, to determine your overall health condition and the status and location of your aneurysm. You’ll also meet with your doctors to discuss pre-procedural instructions and sign appropriate paperwork related to your surgery and hospital stay.
It is important that you discuss all medications that you take with your doctor. If you take blood thinning medication, such as aspirin, you may be asked to stop taking them for a period of time before the procedure, or you may be prescribed aspirin especially for the procedure. Also remember to discuss any allergies you have. This is to ensure that you are not allergic to the contrast dye or anesthesia that will be used during the procedure. During this time, you can make plans for your hospital stay and recovery at home.
Without complications, you can expect to spend a day or two in the hospital after a coiling procedure for an unruptured aneurysm, so make any necessary arrangements for caring for dependents, missing work or school, or taking care of any other obligations. Because activities such as driving, lifting or other strenuous activity will be limited for a week or more after surgery, add a plan for transportation and help around the house while you recover. Pack a bag with the essentials you’ll need for your hospital stay.
How Much Time Does the Medical Team Spend Preparing?
Preparation plays a crucial role in the success of coiling procedures. Members of your surgical team need to:
- Prepare a sterile environment
- Ensure all of the equipment and medicines are present
- Identify relevant prior imaging studies
- Test X-ray and fluoroscopy equipment to assure their adequate performance
- Re-review medical history, laboratory test, and allergies
Doctors use general anesthesia to prevent patients from moving or feeling pain during coil procedures. Administering general anesthesia requires assistance from a trained anesthesiologist who can determine the proper medications to give you during the surgery. The anesthesiologist and his assistance prepare the anesthesia machine and all needed medicines prior to your procedure.
Typically, patients only see the anesthesiologist for a few minutes. Once the medications enter their systems, they lose consciousness. The anesthesiologist, however, must take time to prepare his or her equipment before administering the drugs.
What Happens During a Coiling Procedure?
Coiling is an endovascular procedure – a relatively new and minimally invasive kind of surgery that can access and treat an aneurysm via the patient’s own arteries, rather than opening the skull.
Under general anesthesia, an incision is made in the large femoral artery in the thigh. Through that incision, your neurosurgeon will direct a catheter directly to the aneurysm site.
Once the catheter reaches the aneurysm, a second microcatheter is threaded through it to the aneurysm site, and tiny, flexible coils are inserted into the aneurysm sac to fill it and block blood flow from the artery. In this way, the aneurysm is sealed off from its parent artery so that it can no longer bleed or burst. When the coils are placed correctly, the catheters are withdrawn back through the artery and the incision is sealed.
In some cases, the aneurysm “neck” – the place where it opens off from the artery – is very wide, so doctors may also place a stent or balloon into the artery at the aneurysm site for additional support and to keep blood flowing normally through the artery.
Procedure Length & Recovery
Without complications, a coiling procedure for an unruptured aneurysm typically takes between an hour and a half and three hours. After surgery, you will recover from anesthesia under the supervision of your care team, who will monitor your condition for signs of any complications. You can expect to remain flat in bed for several hours after the procedure. If your condition is stable and no concerns arise, you should be able to return home within a day or so.
At home, recovery time from a coiling procedure is typically short – about a week or so. During that time, activities such as driving and lifting are restricted, with a gradual return to normal routines. Based on your overall health and the status of your aneurysm, your doctors will schedule a series of post-surgery follow-ups to check the status of the coiling and monitor your overall progress.
Factors That Can Affect the Length of Your Procedure
Several factors can affect how long it takes for doctors to complete your coil procedure for brain aneurysms. Since surgeons often don’t know whether they will encounter these factors, they may not be able to tell you exactly how long your procedure will take.
Anatomy, dye and X-rays
The width of your arteries can affect how long it takes your doctor to guide a catheter to your aneurysm. During the procedure, your doctor will use imaging technology (such as an X-ray machine) and contrast dye to make your arteries visible. With a clear view of the arteries, he or she can guide the microcatheter to the right location. If you have tortuous arteries, then it could take your doctor more time to reach the aneurysm. If you have relatively wide arteries, then the process may take less time.
A coiling procedure uses dye to map out the arteries in your body. There is a limit on how much dye can be administered during the total length of the procedure because the kidneys need to be able to clear it safely out of your body.
Dye maps out the way to go and a special form of digital X-rays enlighten the path for the catheter. X-ray exposure is measured throughout the procedure and is typically limited to 90 minutes as a safeguard. Typically, those measures do not limit the procedure in any way, however, there are circumstances where this may be the case, such as a pre-existing kidney impairment which would limit the amount of dye that can be given during any procedure.
Aneurysm Leak/Rupture
In rare cases, microcatheters can cause aneurysms to leak or rupture. If this happens, your doctor will need to fix the leak before he or she can continue with the operation. Although aneurysms don’t often rupture during coiling procedures, it does happen to about 2 percent of patients. This makes it important for you to choose an experienced doctor who specializes in neurosurgery.
Blood Clots
Blood clots can form on the catheter of coils used during your surgery. When clots form, they can break free and block another artery. Research shows that blood clots travel to other arteries in about 8 percent of coiling procedures. Doctors use a drug called heparin to prevent blood clots during operations. Unfortunately, clots still form on occasion. If the clots travel, then your doctor will need to take some time to address the situation before or immediately after finishing the coiling process.
Getting a coil procedure for a brain aneurysm usually means that you will have to take a couple of days away from your typical life. Even though the procedure only takes a few hours, you need to recuperate after you wake up. After just a few hours of surgery, coiling offers excellent benefits to patients at risk of leaking or rupturing aneurysms.
