Brain aneurysms, the abnormal bulging or ballooning of a portion of an artery in the brain, are present in up to 6 percent of the adult population in the United States. If ruptured, an aneurysm can cause bleeding in the brain. This in turn can cause stroke, permanent neurological damage or even death. Ruptured aneurysm is the leading cause of stroke and disability in younger patients, especially women. Traditionally, the only method of treatment involved is surgical clipping, a highly invasive procedure requiring extensive brain surgery and a long period of recovery.
Now, however, an endovascular procedure being done at Ministry Saint Joseph’s Hospital in Marshfield, offers certain patients a less invasive alternative, treating the disease from inside the blood vessel.
Endovascular coil embolization involves tiny platinum coils which are inserted via a catheter into the femoral artery in the patient’s leg. The coils are then deployed into the aneurysm through a micro catheter until the aneurysm is completely filled, thus preventing any blood flow into the aneurysm. Once all the coils are in place, the catheter is removed. Over time, a clot is formed inside the aneurysm, effectively eliminating the risk of rupture. For some aneurysms, stents are also necessary to support the coils in the aneurysm.
“In a major international study (ISAT) comparing surgical clipping to endovascular coiling, it was found that the endovascular procedure produced substantially better patient outcomes, in terms of survival, free of disability, at one year,” said Vivekananda Gonugunta, MD, a Marshfield Clinic endovascular neurosurgeon on staff at Ministry Saint Joseph’s Hospital.
Patient benefits of the coil procedure include:
- A single small incision in the patient’s groin.
- Shorter hospital stays.
- Quicker recovery time.
- Less risk.
Coiling can be used for both unruptured and ruptured aneurysms, and benefits to patients are the same. However, patients with ruptured aneurysms are at very high risk if those aneurysms are not fixed urgently by coils or by surgery. For unruptured aneurysms, the patients are typically stable and coiling is done prophylactically before the aneurysm ruptures.
“Each person’s case needs to be evaluated individually,” said Gonugunta. “The treatment decision largely depends on the aneurysm size, location and neck geometry, as well as the patient’s age and physical condition. It’s important to refer patients to a medical center that offers the full range of options.”
Endovascular treatment is also offered for other conditions like cerebral arterio venous malformations (AVMs), arterio-venous fistulas or tumors that lead to brain hemorrhage.