Coiling

Brain aneurysms are potentially life-threatening conditions that occur when a blood vessel weakens and bulges, increasing the risk of rupture and severe bleeding. Endovascular coiling, also known as aneurysm embolisation, is a minimally invasive procedure used to prevent aneurysm rupture by sealing it off from blood circulation.

What is Coiling?

Coiling is a catheter-based endovascular procedure designed to treat brain aneurysms without open surgery. The procedure involves:

• Inserting a catheter into a blood vessel, typically through the groin or wrist.

• Guiding the catheter to the aneurysm using real-time X-ray imaging (fluoroscopy).

• Deploying soft platinum coils into the aneurysm, filling the space and blocking blood flow.

• Promoting clot formation, which seals the aneurysm and prevents rupture.

This technique effectively isolates the aneurysm from circulation, reducing the risk of rupture while preserving normal blood flow in surrounding vessels.

Benefits of Coiling

• Minimally Invasive: No need for open surgery or skull incision.

• Shorter Recovery Time: Patients typically return to normal activities faster than with traditional surgery.

• Lower Risk of Surgical Complications: Reduced risk of infection and blood loss.

• Suitable for Older or High-Risk Patients: Ideal for those who may not tolerate open surgery.

Coiling has become a preferred treatment for many aneurysms, particularly those in deep or difficult-to-access brain regions.

When is Coiling Recommended?

Coiling is often recommended in the following situations:

• Unruptured Aneurysms: To prevent rupture in patients with high-risk aneurysms.

• Ruptured Aneurysms: To stop active bleeding and prevent further complications.

• Aneurysms with a Narrow Neck: These are well-suited for coiling as the coils remain securely in place.

• Patients Unsuitable for Open Surgery: Those with medical conditions that increase surgical risks.

In some cases, a stent or balloon-assisted coiling may be required for wide-neck aneurysms to keep the coils in place and maintain normal blood flow.

Diagnosis and Treatment Process

Diagnosis: A comprehensive assessment is required to determine the best treatment approach. Diagnostic steps include:

• Neurological Evaluation: Assessing symptoms such as headaches, dizziness, or vision disturbances.

• Imaging Studies

  • Computed Tomography (CT) Scan: Detects bleeding from a ruptured aneurysm.

  • CT Angiography (CTA) or Magnetic Resonance Angiography (MRA): Provides detailed images of blood vessels.

  • Cerebral Angiogram: A catheter-based test to precisely map the aneurysm and determine treatment suitability.

Treatment Process:

• Pre-Procedural Planning: Advanced imaging is used to customise the coiling approach.

• Catheter Insertion: A thin catheter is inserted into an artery in the groin or wrist and navigated to the brain.

• Coil Deployment: Platinum coils are placed inside the aneurysm, promoting clot formation.

• Final Evaluation: The neurosurgeon ensures complete aneurysm closure using imaging.

• Recovery and Monitoring: Patients are monitored closely and may be discharged within a day or two.

Conclusion

Coiling is a safe, effective, and minimally invasive option for treating brain aneurysms, offering a faster recovery and lower surgical risk compared to traditional clipping. While not all aneurysms are suitable for coiling, it is often the preferred approach for high-risk patients or aneurysms in delicate locations.