Surgery

An Overview of Endovascular Coiling



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Endovascular coiling is an alternative process for the treatment of cerebral aneurysms. The actual process itself originated in the 1991 by Guglielmi et al at the University of California, Los Angeles when he first discovered its practical purposes. The practical electrically induced thrombosis has an earlier origin in 1965 for treating aneurysms, but it wasn't until the 1980s that the micro catheters required for the procedure finally were usable. Endovascular coiling is still considered a secondary procedure to treatment cerebral aneurysms to the more popular method of surgically clipping which is when doctors close the base of the aneurysm and then clip it off from further damage or rupturing.

The objective of endovascular coiling is to ensure that the cerebral aneurysm does not rupture which may lead to instant death for the patient. Also, for those aneurysms that have previously ruptured, the goal is to preventing further re-rupturing. In those patients with ruptured aneurysms, endovascular coiling is performed soon after to minimize bleeding risks.

All procedures for aneurysms seek to cut the aneurysm off completely. Surgical clipping accomplishes this by clipping the base of the aneurysm and closing it off. Endovascular coiling builds upon this idea by using  coils which are planted carefully around the base of the aneurysm. The coiling then stimulates the body to have the blood clot where the coils are which eventually seals off the aneurysms which the need of a permanent clip in place.

The procedure, like all procedures involving aneurysms, is very complex and requires highly skilled doctors to perform successfully. In the case of endovascular coiling, an interventional neuroradiologist are often used which the patient with the aneurysm is put under basic anaesthesia.  Fluoroscopic imaging is the guiding force that helps the neuroradioligists perform the procedure. A guiding catheter is entered in from the patient's femoral artery which travels to the aneurysm and helps the doctors make a better assessment of how to proceed. Then, a micro catheter enters in from the femoral artery to the spot of the aneurysm. Detachable platinum coils are inserted around the base of aneurysm using the micro catheter.

Because endovascular coiling is less invasive than surgical clipping, patients have experienced faster recovery times. There is a fear that endovascular coiling leads to re-bleeding in the future. There is still a debate on whether endovascular coiling is better than surgical coiling, and experts have not yet reached a consensus. 

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ARTICLE SOURCES AND CITATIONS
  • InfoBoxCallToAction ActionArrowhttp://pmj.bmj.com/content/87/1023/41.abstract
  • InfoBoxCallToAction ActionArrowhttp://www.neurosurgery.pitt.edu/cerebrovascular/endovascular/treatments/gdc.html
  • InfoBoxCallToAction ActionArrowhttp://stroke.ahajournals.org/content/35/6/1399.abstract