Intracranial Aneurysm Embolization

What is an intracranial aneurysm?

An intracranial aneurysm is a dilatation or ballooning at a weakened point of an artery in the brain. Long term observation of these aneurysms has shown that they usually continue to increase in size, and as they get larger the risk of rupture increases. A rupture of an aneurysm causes release of blood from the artery into the brain which may result in a serious stroke or death. Prior to the early to mid 1990s, the usual treatment has been surgical clipping of the aneurysm to prevent rupture.

Treating intracranial aneurysms by placing platinum detachable coils has been available since the early 1990’s. This procedure is considered an acceptable alternative to surgical clipping for many patients, including those patients who are not considered surgical candidates for an aneurysm clipping. The coils initiate blood clot formation within the aneurysm, and when enough coils have been placed, the aneurysm is blocked from receiving further blood flow.

How do I prepare for an intracranial aneurysm embolization?

Prior to your procedure you will be asked to undergo the following tests or procedures to evaluate your condition and aid in measuring the size and shape of your aneurysm.

History and Physical Examination
Blood tests
Neurological Examination
Imaging (CT, MRI, MRA)
Cerebral Angiography

A cerebral angiogram is an x-ray procedure that demonstrates the blood vessels in the brain. Contrast media (a liquid dye that may be seen on x-rays) is injected into a vein or artery, and x-ray pictures are then taken in rapid succession. The series of pictures reveals the size and shape of veins or arteries and vessel abnormalities.

How is the embolization procedure performed?

Prior to the embolization procedure, you will either be put to sleep with general anesthesia or you will be given medications through your intravenous line to make you feel drowsy and relaxed. Your physician will determine which approach is best for you based on his/her clinical judgment. Your physician will also inject a local anesthetic in your groin area where the catheter will be inserted. He/she will then make a small puncture in your groin to access the femoral artery in your leg. A thin tube called a catheter is then introduced through the artery and advanced to the affected artery in your brain under x-ray guidance.

After determining the size of the aneurysm, the physician will select the appropriate size coils to fill the aneurysm. The coils are then advanced through the catheter to the aneurysm site. The coils are positioned and detached one at a time until the physician determines the aneurysm has been satisfactorily occluded.

After the procedure you will be monitored over night in a recovery room or in the intensive care unit. If there are no untoward events, you will be discharged approximately two days after the procedure. It is important that patients adhere to follow-up appointments with their doctor and have an angiogram during the first year after the procedure to ensure that the aneurysm remains occluded and does not continue to grow. If the aneurysm does enlarge, it may be treated again using the same coil embolization technique as previously described.