Deaconess Gateway Hospital in Newburgh is the only facility in the region that offers aneurysm embolization, or “coiling,” a new method for repairing both ruptured and unruptured aneurysms in the brain.
In coiling, a neurovascular surgeon threads a catheter through a small incision in the groin to the site of the aneurysm. Through the catheter, the physician places numerous soft platinum coils, narrower than a human hair, into the aneurysm. The body develops a blood clot around the coils. The packed coils and the blood clot effectively prevent blood from entering the aneurysm, essentially eliminating the risk of the aneurysm rupturing.
A stent may also be used in this procedure if the neck of the aneurysm is wide. The stent covers the neck of the aneurysm and helps keep the coils in place. This method of stent placement prior to coil placement has allowed treatment of certain aneurysms that were previously considered untreatable.
Aneurysm coiling is most often performed under general anesthesia, but local anesthesia can also be used. Results of this procedure have been promising, with long-term follow-up showing permanent success in more than 80% of cases. This is a comparable success rate to surgical clipping.
Indications for Coiling
Coiling may be performed as a preventive measure in people with an unruptured aneurysm or as treatment for patients who have experienced rupture of the aneurysm. It is an alternative to surgery when surgical treatment is considered high risk.
Not every patient is a suitable candidate for aneurysm embolization. When both treatments are considered reasonable (surgical clipping or coiling), there are certain factors that would favor endovascular coiling:
- Patient can’t have or doesn’t want to receive a blood transfusion, which may be necessary during surgery.
- Patient can’t receive general anesthesia.
- Embolization has a significantly shorter recovery period.
- Embolization has fewer potential complications.
Risks Involved in Coiling
There are some risks associated with this procedure, similar to those with surgical clipping. Coil embolization of an unruptured aneurysm carries less risk than embolization of an acutely ruptured aneurysm.
During catheter placement within the blood vessels, there is a risk of damage to a blood vessel, bruising or bleeding at the puncture site, or infection. Rarely, patients may experience an allergic reaction to the contrast material used during the procedure.
There is a possibility that the coil and blood clot won’t adequately prevent blood flow into the aneurysm. In some cases, repeating this procedure will achieve complete obstruction.
Patients could experience stroke-like symptoms after the procedure, such as weakness in a limb, numbness, tingling, speech disturbances and visual problems. Serious complications such as permanent stroke or death are rare.
Contraindications for coiling include:
- Currently pregnant or nursing
- Previous reaction to iodine or contrast material
- Renal disease
- Asthma with inhaler use two times or more per day