Endovascular Treatment of Cerebral Aneurysms

Unruptured Cerebral aneurysms

These are usually incidentally discovered aneurysms.

Not all cerebral aneurysms need to be treated as the risk of hemorrhage is dependent on the size and location of the aneurysm.

We can discuss the indications, risks and benefits of treatment procedures.

Ruptured cerebral aneurysms

A ruptured cerebral aneurysm causes bleeding around the surface of the brain called a subarachnoid hemorrhage.

This is a very serious condition with a high mortality rate. Twelve percent of patients die before even reaching the hospital.

If left untreated the mortality is 60% over the first month.

The major factor that determines the outcome is the re rupture rate which is about 2% per day for the first few weeks. A re rupture has a 50% mortality rate.

This is therefore a very serious condition and the most effective way of improving prognosis is the prevention of re rupture.

Early treatment therefore improves the outcome.

This can be done with endovascular treatment (coiling) or surgical clipping.

The shape of the aneurysm and the relationship to the parent vessel determines whether the aneurysm should be treated with coiling or clipping.

In general the coiling is associated with a lower treatment risk (according to the ISAT trial data).

Endovascular Treatment Procedure

The procedure is done under general anesthetic and access is obtained from a femoral artery in the groin.

A diagnostic cerebral angiogram is performed and the aneurysm is analyzed.

A very thin micro-catheter is placed very carefully into the aneurysm and through this micro-catheter a number of platinum coils are placed. This will prevent blood flow into the aneurysm and therefore the aneurysm can not bleed again.

Additional intensive care is needed to manage other complications such as arterial spasm and hydrocephulus.

Risks / Complications of Coiling

The overall risk is low especially when compared to the risk of not treating a ruptured aneurysm.

Risks include :

  • Bleeding from the arterial access in the groin after the procedure
  • Stroke caused by blood clots forming on the catheters or coils
  • Stroke due to damage to arteries caused by catheters or guide wires
  • Rupture of the aneurysm during treatment - about 1% chance (associated with high mortality)

Follow up

After coiling of an aneurysm there is a risk of recurrence due to coil compaction or aneurysm growth. According to the literature the recurrence rate is 20% of which half of the cases may require additional treatment.

We found the recurrence rate in our practice to be lower.

In view of the risk of recurrence the coiled aneurysm must be followed up.

We do routine follow up angiography at 6 months and at 2 years we do angiography or MR angiography.

MR angiography is recommended every 2 years thereafter.