Therapy of the aneurysm by coiling

The treatment method of an aneurysm called coiling is a relatively new and very effective treatment of an aneurysm that has not yet ruptured. If an aneurysm is suspected in the area of a blood vessel in the brain, a vascular imaging must first be performed. For this purpose, a catheter is pushed over the inguinal artery to a short distance from the section where brain-supplying arteries come off.

A contrast medium is then injected and an X-ray image is taken at the same time. The vessels now appear as in a riverbed. Bagging is clearly visible by contrast medium enrichment.

If a decision is now made for treatment, the coiling procedure can be used.Platinum-coated, wafer-thin spirals are pushed over the groin catheter upwards into the bagged vessel and deposited there. The spirals now almost completely fill the bagged out area. Within a very short time, the blood flowing past forms small blood clots.

The vessel is also called thrombosed. Soon, the blood clots fill the whole of the bagged out area and seal it. The coiling process is very successful.

The probability that the vessel will rupture at the coiled point is very low. The coils remain in the vessel forever. Despite its success, the coiling process also has risks that must be considered and weighed up.

When the catheter is advanced, a blood clot can form which is washed out into the brain and causes a stroke. A further risk of the coiling procedure is that the already very thin wall of the sacculated part of the blood vessel may tear. This would lead to a dramatic bleeding into the brain. If the patient is planned to be thrombosed for weeks, blood clots can be carried over into the brain, which can then lead to an acute stroke.

Clipping surgery for cerebral artery aneurysm

As an alternative to the coiling procedure, the so-called open clipping operation, which has been in existence for some time, can also be used to treat a cerebrovascular aneurysm. This operation is performed when the coiling procedure cannot be performed due to contraindications or when the aneurysm has exceeded a critical size and can no longer be treated by coiling. The most common reason for clipping rather than coiling is the bleeding of an aneurysm after it has ruptured.

However, clipping operations can also be planned, i.e. they can be performed without emergency and with the appropriate preparation and planning time. Advantages and disadvantages in comparison to clipping and coiling are, according to the current state of knowledge, balanced. With the clipping method, surgery must be performed on the open head.

For this purpose, an incision is made behind the hairline and an access to the brain is created. Important nerves, such as the optic nerve and important arteries must be located and displayed in order to obtain appropriate orientation. Once the vessel with the sacculation has been found, a clip is placed in front of the sacculation.

The blood is thus prevented from passing through the sacculated blood vessel and seeks a bypass circuit. The surgeon uses a dye that is placed in the vessel to make sure that the blood now finds another way and that all sections of the brain are supplied with sufficient blood. The operation takes about 3-6 hours, depending on the size of the aneurysm and the accessibility and location of the aneurysm.

After monitoring in the intensive care unit, the patient is mobilized. On the following day, a CT scan of the skull is performed to check if there is any brain swelling after the surgery. On the 7th day after the surgery, a so-called angiology is performed. This is a vascular imaging to show whether the clip has maintained its position and whether the blood flow to the brain is still normal.