Endovascular Coiling is the most recent and minimally invasive procedure to block the blood flow to a brain aneurysm, a weakened area in the artery wall. If left untreated it may rupture and cause internal bleeding which is a life threatening situation. The procedure called coiling where a long tube looking like a spring, made up of platinum is inserted through artery guided by the X-rays to reach the area and seal off the aneurysm. The endovascular coiling procedure is superior to the standard clipping method where an opening is made in the skull to reach in to the aneurysm. The new procedure does not involve opening of the skull with shorter hospitalization stay. However this procedure is not suitable for all the patients.
Risk factors for Brain Aneurysm:
- Family history
- Excessive drinking
- High blood pressure
Symptoms of ruptured Brain Aneurysm:
- Severe and sudden onset of headache
- Stiffness in the neck
- Double vision/Blurred vision
- Dizziness and trouble walking
- trouble walking or dizziness
- Vomiting and nausea
- Computerized tomography– The initial test is a CT scan to determine the bleeding pattern in the brain. The test generates 2-D slices of the brain. Another test called CT angiography will be done using a contrast dye to detect the presence of aneurysm.
- Magnetic resonance imaging (MRI)– MRI test will generate detailed 3-D brain images using magnetic field and radio waves. The presence of aneurysm can also be detected using MRI angiography.
- CF- test– This test referred as cerebrospinal fluid test which will be advised if the bleeding cannot be detected in CT. Cerebrospinal fluid will be collected from the back using a needle called lumbar puncture to detect the aneurysm.
- Cerebral angiogram- The test is invasive which will be used when other tests not provide adequate information. During the test a thin and flexible catheter will be inserted through the groin through which a special dye will be injected to create a series of X rays to detect the aneurysm.
- The patient has to sign an informed consent form which should be carefully read and understood. He has to ask any questions if something is not clear before the procedure.
- The patient has to inform the medical staff about previous allergic reactions to any contrast dyes or to iodine.
- The patient has to inform whether he is sensitive to any medicines, or anaesthetic agents.
- Fasting before the surgery is generally recommended depending on the condition sometimes it may be overnight or for a few hours.
- Ongoing medications should be informed to the medical staff.
- Information about the past medical history such as bleeding disorders which may affect the blood clotting during the surgery should be shared with the doctor.
- Complete blood profile and other blood tests would be done before the surgery
During the procedure
- The procedure often requires two or more health care providers, a neurosurgeon who will monitor the brain condition and an intervention radiologist who will assist in all the radiological procedures.
- The patient will be asked to remove clothing, metallic accessories such as hairpins and other objects which will interfere with the procedure and should wear the hospital gown.
- Bladder should be emptied before the procedure and the patient is asked to lay down on the back on a X ray table.
- An intravenous catheter is placed on the arm and connected to ECG monitor to record the electrical activity of the heart. Blood pressure, pulse and neurological signs are continuously monitored during the procedure.
- A catheter is placed in the bladder to drain the urine.
- Local anaesthetic is applied on the site of incision and expose the artery in the groin
- A small incision is made in the skin to expose the artery in the groin.
- A small catheter is inserted in to the artery in the groin which will be guided through the blood vessel to the brain using special type of X rays
- After the catheter is properly guided to the affected artery, dye is injected to make the aneurysm and related blood vessels to show where they are located to measure the shape and other features.
- Later a small coil is inserted through the initial catheter to place the coil in to the affected area
- When the coil is properly placed it will be separated from the catheter. Often more than one coil is required to completely seal the aneurysm
- After proper sealing additional X rays were required to check the accuracy of the procedure
- The coil is then permanently placed in the affected artery after the sealing and the catheter is removed
- Dressing is applied on the insertion site and monitored
After the procedure
- After the procedure the patient is transferred to the recovery room if the condition is stable and the procedure was done for unruptured aneurysm
- If the procedure is performed for ruptured aneurysm the patient is transferred to ICU and kept under observation
- In most cases the patient may go home after 2 days post procedure.
- Some patients after the procedure for a ruptured aneurysm are referred to rehabilitation facility to heal the damage caused as a result of the ruptured aneurysm
- Strenuous activities should not be done for up to 6 weeks
- Changes in the body after the procedure such as seizures, severe headache, loss of consciousness and any other neurological changes have to be immediately reported
- The first angiogram may be done about one month after the procedure followed by additional cerebral angiograms done at mean time
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