About the Procedure
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Aneurysms are small outpouchings from of vessel wall. It is believed that the vessel is weak at this area. This small outpouching has a tendency to grow reducing an extremely friable or which is liable to burst at any moment.
When an aneurysm ruptures in the brain, the patient experiences headache of such severity that it is termed thunder clap headache.Close to 20 % of patients never reach the hospital at all. Another 20% will die in the next two weeks unless the aneurysm is treated.Aneurysms which have bled have a very high likelihood of bleeding again in the next few days and definite treatment for the same should be given at the earliest.
Endovascular coiling is an innovative technique where, this weak area in the blood vessel of the brain is repaired by packing this this outpouching with multiple medical coils which obliterates the sac completely. The procedure is done by a small puncture in the blood vessel of the thigh without opening the brain and skull.
SAH and Aneurysm
When an aneurysm
ruptures in the brain, the patient experiences headache of such severity that it is termed thunder clap headache.Close to 20 % of patients never reach the hospital at all. Another 20% will die in the next two weeks unless the aneurysm is treated.Aneurysms which have bled have a very high likelihood of bleeding again in the next few days and definite treatment for the same should be given at the earliest.
Till a few years ago the only treatment available for intra-cranial aneurysm was open surgery . Here the skull was opened and the connection between the abnormal sac and the main vessel excluded by placing a specially designed surgical clip . However this surgery is risky and also difficult in certain locations ,particularly in the elderly and when the patient is semi or unconscious.
In the mid Nineties a revolutionary treatment was developed by Dr. Guglielmi, an Italian neuro-radiologist, where a fine tube is inserted from a needle puncture in the leg . This tube is navigated under advanced image guidance into the aneurysm and the sac delicately packed with very fine soft platinum wires shaped to look like coils that match the size of the aneurysm . Several such coils may be required to close an aneurysm ,this basically depends on the size of the abnormal sac.
The actual procedure may vary depending on the size of the junction between the sac and the normal blood vessel (neck). When this is small only coils are used , when its moderately large a balloon may be used to help packing the aneurysm.When the neck is really wide, a metal tubular mesh(stent) is first deployed across the neck and then the coils packed.(animation).
Although there is no major external surgery ,the procedure is ideally performed under general anesthesia to keep the blood pressure under control and to also to ensure that the patient does not move.
Following the procedure the patient may return to the room or the ICU . This depends on the severity of the initial bleed.A patient who has SAH is also prone for vaso-spasm where the blood vessels of the brain may contract as a result of the blood that has leaked out and at times this can prove fatal especially if the initial bleed is large.
Every patient who has coiling performed is advised to undergo followup angiography after six months, since in about 5-18% patients a part of the aneurysm may reopen in some this may be significant and additional coils may be required for stability.
Even though this procedure is safer than open surgery, during the acute stage the following complications are possible - rupture of the aneurysm during coiling, clot formation in a normal blood vessel during the procedure or coils occluding a normal vessel.All these can lead to permanent disability or may even prove fatal.
if you would like to read more about the advantages of the procedure ,you may read the path breaking study - the ISAT trial.
Stent Assisted Coiling