Endovascular coiling to treat brain aneurysms is one of the latest methods in this field, and Turkey has been interested in developing this surgery due to the seriousness of aneurysms and their many complications.
Endovascular coiling is a new technique that treats aneurysms prophylactically for non-bleeding aneurysms or therapeutically after bleeding without opening the skull with X-ray guidance. Compared to other procedures, it minimizes complications and is a minimally invasive method suitable for those who cannot perform surgery.
The treatment of brain aneurysms (aneurysm treatment) is important and urgent because it is a life-threatening condition if the aneurysm wall is perforated. Is endovascular coiling a final solution to this issue? What are the symptoms of a head aneurysm? Follow us in this article.
What is endovascular coiling used to treat brain aneurysms?
An aneurysm is a weak area in the wall of an artery that causes a balloon or sac to form in the vessel. The wall of the sac is thinner than the rest of the artery wall and is at risk of bleeding after it exceeds a certain size. A brain hemorrhage is a potentially fatal emergency. This type of aneurysm is known as a berry aneurysm or a saccular aneurysm, based on how it appears. If a brain aneurysm ruptures, it causes bleeding in the brain.
Other types of aneurysms include a lateral aneurysm, where a bulge appears along one wall of an artery, or a fusiform aneurysm, which is when an entire artery becomes enlarged.
The exact cause of aneurysm formation is unknown; the causes can be genetic (inherited in families) or occur in a pregnant woman due to an abnormality during pregnancy.
Some diseases can lead to weakened artery walls and the formation of aneurysms, including polycystic kidney disease, certain connective tissue disorders, or blood vessel abnormalities.
Injury, high blood pressure, or drug use may also increase the risk of aneurysms; in rare cases, an infection within the artery wall can cause aneurysms to form.
Endovascular Coiling
Endovascular coiling is a treatment method for aneurysms without opening the skull or performing brain surgery.
A coil is a tiny, thin wire assembled inside an aneurysm. It blocks blood flow to the aneurysm by forming a blood clot while the rest of the artery remains open to carry blood to the brain.
The wire is inserted through a catheter through the body’s large arteries into the arteries of the brain. This treatment is performed as an alternative to aneurysm clipping (surgically isolating an aneurysm by placing a clip at its base to prevent blood from entering it), which requires brain surgery and opening the skull to isolate the aneurysm.
Symptoms of ruptured brain aneurysms
We will mention the symptoms of ruptured aneurysms because unruptured brain aneurysms are mostly asymptomatic unless they reach large sizes.
Symptoms of a ruptured aneurysm include:
- Sudden, severe headache
- epileptic seizures
- Speech disorder
- Muscle weakness is related to where the aneurysm is located
- Confusion or changes in perception
- Vision changes
- Permanent brain damage may occur
Who needs endovascular coiling?
Many patients can undergo endovascular coiling; the procedure can be performed whether the aneurysm is intact or ruptured.
Younger patients and elderly individuals may be good candidates. The size and shape of the aneurysms determine whether a patient can undergo angioplasty or require open surgery. After diagnosing the presence, shape, and location of the aneurysms and the patient’s age and associated diseases, healthcare providers may choose this procedure over open surgery for patients who may not be in good health for major brain surgery.
You can also read on our website about hydrocephalus and its treatment in Turkey.
What happens during the endovascular coiling procedure?
On the day of the procedure, patients are admitted to the hospital, not allowed to eat or drink, and an intravenous catheter is opened to provide them with fluids.
At the time of the procedure, the patient is taken to a special room in the radiology department, where anesthesia or sedation is used to help the patient relax.
A catheter, or long tube, is inserted from the groin into the femoral artery and carefully threaded through the aorta (the body’s main artery) The catheter is guided through X-rays to reach one of the arteries that enter the brain.
A contrast dye will be injected to precisely locate the aneurysm and the surrounding capillaries and blood vessels using X-ray imaging. Small wires are then inserted through the catheter (usually made of platinum) and coiled into the aneurysm. Additional wires are implanted in this way until the aneurysm is full.
After the wires are fully inserted and the artery is checked to ensure that the aneurysm is closed with the coil, the artery is checked for injury, and the catheter is removed.
To prevent bleeding, the area where the catheter was inserted into the femoral artery is pressed firmly for several minutes, and then a bandage is applied.
After the procedure is completed, patients are monitored for several hours.
After the procedure, patients may be allowed to go home the same day; however, if the procedure is performed to treat bleeding aneurysms, patients may be hospitalized for several days or weeks.
There are usually some activity restrictions for several days after the endovascular coiling procedure, including no driving or working and some weight-lifting restrictions. Patients need to be followed up about a month after the procedure to ensure there are no complications.
Endovascular coiling vs. Surgical procedure
Surgical techniques have changed over the years; surgeons now make very small incisions to access aneurysms, reducing the disability and length of recovery time for surgical cuts that require opening the skull to access the aneurysm.
Data collected for both types of procedures have been evaluated, and it indicates that patients who undergo endovascular coiling have shorter hospital stays, fewer complications, and faster recovery times.
What is the recovery time after endovascular coiling?
Recovery times vary for each patient depending on the patient’s overall condition, the location of the aneurysm, and whether it has ruptured.
For patients with unruptured aneurysms who undergo endovascular coiling, recovery times can be as short as a month.
In the case of a ruptured aneurysm, recovery can take weeks to months, depending on the amount of bleeding, the extent of damage to neighboring tissues, and the area of the brain where the aneurysm is located.
Complications of endovascular coiling
There are some potential risks associated with aneurysm coiling. These can include injury or damage to the artery or aneurysm being treated, and in rare cases, the aneurysm can rupture.
A vasospasm, or sudden narrowing of an artery, can occur, resulting in reduced blood flow to the brain fed by that artery.
A blood clot can form on the catheter or coils while they are being injected or in the artery where the catheter is fed. If this happens, the clot can block blood flow or cause a stroke.
The coils may not stay in place or completely block the aneurysm, which can cause it to grow larger. Patients may also have an allergic reaction to the dye used during the procedure. There is a risk of infection with any procedure.
Endovascular coiling to treat intracranial aneurysms is a safe procedure with fewer complications and a faster recovery time than other procedures. That is why Turkey has recently adopted this procedure and applied it in most of its hospitals.
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