Brain Aneurysm Coiling(Endovascular treatment of brain Aneurysms)

Dr. Avinash KMMS, MRCS Ed(UK), Mch (KEM, Mumbai), FINR(Switzerland), FMINS(Germany),

• Interventional & Neurovascular surgeon and Stroke specialist, • Endoscopic Neuro and Spine surgeon, • Minimally invasive Neuro and Spine surgeon (FMINS).

mob: 9740866228, E mail: doc_avin@hotmail.com

Consultant Neurosurgeon and Neurointerventionist

Columbia Asia Hospital, Bangalore.

What is brain Aneurysm?A brain aneurysm, also referred to as a cerebral aneurysm or intracranial aneurysm (IA), is a weak bulging spot on the wall of a brain artery very much like a thin balloon or weak spot on an inner tube. Over time, the blood flow

within the artery pounds against the thinned portion of the wall and aneurysms form silently from wear and tear on the arteries. As the artery wall

becomes gradually thinner from the dilation, the blood flow causes the weakened wall to swell outward. This pressure may cause the aneurysm to

rupture and allow blood to escape into the space around the brain. A ruptured brain aneurysm commonly requires advanced surgical treatment

Treatment options for Brain Aneurysms:• Surgical clipping :• Endovascular coiling• Parent artery sacrifice with or with out bypass surgery.

• Conservative management (no treatment)

Endovascular treatment for Brain aneurysms:

• Coiling of aneurysm:

• Stent assisted coiling:

• Balloon assisted coiling:

• Flow diverters:

Coiling of aneurysm:Endovascular (meaning within the blood vessel)

embolization, or coiling, uses the natural access to the brain through the bloodstream via arteries to diagnosis and treat brain aneurysms. The goal of the treatment is to safely seal off the aneurysm and stop further blood from entering into the aneurysm and increasing the risk of rupture or possibly rebleeding.

Following diagrams show how aneurysm coiling is done

Coil mass inside aneurysm prevents blood from entering it

Watch videos to know more about coiling:

Following videos demonstrate the procedure of aneurysmal coiling.

http://www.youtube.com/watch?v=-dYC1gyqomM

http://www.youtube.com/watch?v=eLIPCvT49yI

http://www.youtube.com/watch?v=5Ss-IOmFyeA

Balloon assisted coiling:In slightly wide necked aneurysms balloon assistance is taken to coil an

aneurysm in order to prevent prolapse of coil mass into the artery.

Stent assisted coiling:For wide necked aneurysms stent can be placed to hold coil mass

inside the aneurysm.

Other techniques of stent assisted coiling in wide necked aneurysms

Using double stents in Y shape to coil complex wide necked aneurysms

Watch following video for better understanding of technique

http://www.youtube.com/watch?v=MfdPbBZ6ETs&feature=related

Flow diverter:Flow diverter is a kind of stent which can be used with out use of coils.

Watch following video for better understanding

http://www.youtube.com/watch?v=jd5VQTS096E&feature=related

Which one of the two modalities is better? Coiling or Clipping?

Morbidity and Mortality:

ISAT TRIAL (for ruptured aneurysms): Dead or dependent at one year-

• Surgical group: 30.6% patients were dead or dependent at one year

• Endovascular group: 23.7% of patients were dead or dependent at one year

ISUIA trial (for unruptured aneurysms) Death and dependency at 1 year:

• Surgical group: The 1-year morbidity and mortality rate was 12.2%, and the mortality rate was 2.3%.

• Endovascular treatment: The 1-year total morbidity and mortality rates were 9.5% and 3.1%, respectively.