Endovascular treatment of intracranial aneurysms

What is endovascular treatment of intracranial aneurysms?

An aneurysm is an outward bulging of a blood vessel wall due to a weakness in the wall of a blood vessel. This causes the blood vessel to swell. When an aneurysm develops inside the brain, it is called an intracranial aneurysm. Depending on their size, intracranial aneurysms are associated with a high risk of bleeding in and around the brain, which can have catastrophic consequences. Endovascular treatment of intracranial aneurysms is the non-surgical treatment of intracranial aneurysms using microcatheters (small and flexible plastic tubes) and X-ray guidance.

The procedure involves inserting tiny metal spirals (coils) into the blood vessel to act as a physical barrier and encourage blood clotting, preventing bleeding. A metal mesh tube (stent) may be used to keep the coils in place and support the walls of the blood vessel. Sometimes only stents are used without coils to change the blood flow and encourage clotting in the aneurysm. A special typeof stents calledflow diverters redirect blood flow without blocking side branches originating from the aneurysm.

How does the procedure work?

You will be under general anaesthesia for the procedure. Using fluoroscopy for guidance, the interventional radiologist will insert a catheter through an artery in your groin or arm and will move it to the location of the aneurysm.

The interventional radiologist will then deposit tiny metal coils, a stent, or flow diverter through the catheter and into the aneurysm, which stimulates blood clotting. Filling the aneurysm in this way stops blood flow to this area.

Why perform it?

A ruptured intracranial aneurysm that causes bleeding to the brain or to the surface of the brain should be treated urgently to stop the bleeding, minimise damage to the brain and prevent bleeding in the future. Dependent on size, unruptured aneurysms are sometimes treated to minimise any future risk of bleeding

What are the risks?

The procedure carries a risk of the aneurysm bursting, leading to bleeding in and around the brain. One or more of the coils may move out of place in the aneurysm, or blood clots may develop during or after the procedure, either of which may block important blood vessels with deriving stroke. During or directly after treatment, a narrowing of cerebral arteries can occur, which is called vasospasm. The consequence of vasospasm is worsening of blood supply and possible stroke. Vasospasm is treated by applying drugs using a small catheter, similar to treatment procedures used for aneurysm treatment to improve brain blood supply. After treatment, you will probably be prescribed treatment for at least three months to prevent blood clots developing. Follow-up examination with MRI or Fluoroscopy is necessary to evaluate if the treatment was successful.