Aneurysm Coil Embolization (Endovascular)
Aneurysm coil embolization is an endovascular treatment that excludes a brain aneurysm from the circulation by filling its sac with platinum coils delivered from inside the blood vessel. A catheter is advanced, usually from the groin, to reach the aneurysm sac, where the coils are deployed.
Останнє оновлення: 2026-06-09
Definition
Coil embolization (coiling) is an endovascular technique in which a brain aneurysm is treated from inside the blood vessel without opening the skull. A fine microcatheter is advanced under fluoroscopic (angiographic) guidance into the aneurysm sac, which is then filled with detachable platinum coils. The coils slow blood flow within the aneurysm, promoting clot formation and, over time, exclusion of the sac from the circulation. The method developed as an alternative to open surgical clipping (closing the aneurysm neck with a clip) and may be the first choice in suitable cases.
Indications
Coiling may be considered for both ruptured (bled) and unruptured (incidentally found) brain aneurysms. The decision rests on the aneurysm location, size, dome-to-neck ratio, the patient's age and general condition, and the team's assessment. In many patients presenting with subarachnoid hemorrhage who are suitable for both coiling and clipping, coiling may be preferred; this approach is supported by the randomized ISAT trial. Wide-necked or complex aneurysms may require adjunctive techniques such as balloon- or stent-assisted coiling.
Procedure
The procedure is usually performed under general anesthesia in an angiography suite. A sheath is placed in the groin (femoral) or wrist (radial) artery, and a catheter is advanced through the neck vessels into the cerebral arteries. After a road-map angiogram, a microcatheter is introduced into the aneurysm sac. Detachable coils are deployed one by one to fill the sac progressively, with each coil assessed by control injections. To prevent protrusion across a wide neck, a temporary balloon may be inflated or a permanent stent placed. Once adequate packing and flow arrest are confirmed, the catheters are withdrawn and the access site is closed.
Advantages and Limitations
The main advantage of coiling is that the skull is not opened, which for many patients can mean a less invasive course and often a shorter hospital stay. In contrast, coiled aneurysms may show recanalization (refilling over time) and a need for retreatment more often than after surgical clipping, so angiographic follow-up is required. Stent-assisted techniques require blood-thinning (antiplatelet) medication. Not all aneurysms are suitable for endovascular treatment, and in some cases clipping may be more appropriate; the choice of method is made on a case-by-case basis.
Recovery and Risks
For unruptured aneurysms, recovery is usually rapid and the patient may mobilize early; for ruptured aneurysms, recovery depends on the severity of the hemorrhage and any accompanying complications. Possible risks include stroke from clot embolization or vessel occlusion during the procedure, aneurysm rupture, bleeding at the access site, and incomplete coiling. The aneurysm may refill in the future and require retreatment. No outcome is guaranteed; the decision is individualized by considering the patient's clinical status, imaging findings, and expectations together.
Джерела
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1457-1462.
- Spetzler RF, Kalani MYS, Nakaji P, eds. Neurovascular Surgery. 2nd ed. Thieme; 2015.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011.
- Molyneux A, et al. International Subarachnoid Aneurysm Trial (ISAT): a randomised comparison of coiling versus clipping. Lancet. 2002.
Ця стаття має загальний інформаційний характер і не замінює огляду лікаря. Рішення щодо діагностики та лікування є індивідуальними.