What is endovascular coiling?
Endovascular coiling is a procedure performed to block blood flow into an aneurysm (a weakened area in the wall of an artery). Endovascular coiling is a more recent treatment for brain aneurysms; it has been used in patients since 1991.
Endovascular coiling is a minimally invasive technique, which means an incision in the skull is not required to treat the brain aneurysm. Rather, a catheter is used to reach the aneurysm in the brain.
During endovascular coiling, a catheter is passed through the groin up into the artery containing the aneurysm. Platinum coils are then released. The coils induce clotting (embolization) of the aneurysm and, in this way, prevent blood from getting into it.
How is endovascular coiling performed?
A microcatheter is inserted through the initial catheter. The coil is attached to the microcatheter. When the microcatheter has reached the aneurysm and has been inserted into the aneurysm, an electrical current is used to separate the coil from the catheter. The coil seals off the opening of the aneurysm. The coil is left in place permanently in the aneurysm. Depending on the size of the aneurysm, more than one coil may be needed to completely seal off the aneurysm.
The coils used in this procedure are made of soft platinum metal, and are shaped like a spring. These coils are very small and thin, ranging in size from about twice the width of a human hair (largest) to less than one hair's width (smallest).
Fluoroscopy (a special type of x-ray, similar to an x-ray "movie") aids in this procedure. The catheter, which is inserted into an artery in the groin, is guided by a small wire inside of the catheter along the length of the blood vessel to reach the area of the aneurysm. The physician uses fluoroscopy to guide the catheter to the aneurysm's location in the brain.
Reasons for having coiling performed:
A coiling procedure may be performed to treat an unruptured brain aneurysm. Coiling may be used to treat a ruptured brain aneurysm in some cases, as well as for patients who are older or who cannot undergo surgery.
There may be other reasons for your physician to recommend a coiling procedure.
Treating aneurysms at Johns Hopkins:
The Johns Hopkins Cerebrovascular Team evaluates each brain aneurysm patient to decide the best singular therapy or treatment combination (clipping or coiling) for the patient’s specific case. Johns Hopkins is one of the few hospitals in the country that treats about 200 aneurysm cases a year. We have published our aneurysm treatment results, which rank among the best in the world.
Read an article by Drs Judy Huang and Rafael Tamargo on Microsurgical Clipping and Endovascular Coiling of Intracranial Aneurysms.