HomeProceduresCoiling of Brain Aneurysms

Coiling of Brain Aneurysms

Endovascular coil embolisation is a minimally invasive, highly effective treatment to seal off brain aneurysms from the inside preventing rupture without open brain surgery.

Neuro-Interventional Procedure

What is Brain Aneurysm Coiling?

A cerebral aneurysm is a weak, balloon-like bulge in the wall of a brain artery. If it ruptures, it causes a subarachnoid haemorrhage a life-threatening brain bleed with catastrophic consequences. Endovascular coiling is a technique where soft platinum coils are delivered through a catheter into the aneurysm sac, packing it tightly so that blood can no longer flow in and clot forms permanently within, eliminating the risk of rupture.

This catheter-based approach is an alternative to open neurosurgical clipping and is now the preferred treatment for many aneurysms, particularly those at the base of the skull. The landmark ISAT trial confirmed that endovascular coiling resulted in better outcomes than surgical clipping for most intracranial aneurysms.

Who Needs Aneurysm Coiling?

Aneurysm coiling is considered for patients with ruptured aneurysms causing subarachnoid haemorrhage, where it is performed as an emergency life-saving treatment. It is also used for unruptured aneurysms that are incidentally detected on brain imaging (CT or MRI) but carry a significant risk of future rupture. This approach is particularly beneficial for aneurysms located in areas that are difficult to access through open surgery, such as the posterior circulation or skull base. It is often preferred in elderly patients or those with significant medical comorbidities, where the risks associated with open craniotomy are higher. Additionally, it is a suitable option for patients who prefer a minimally invasive approach, provided the aneurysm anatomy is favourable for endovascular treatment.

How is the Procedure Performed?

  • Anaesthesia: The procedure is performed under general anaesthesia to ensure you remain completely still during the precise catheter navigation.
  • Groin Access: A small puncture is made in the femoral artery at the groin. A sheath and guide catheter are introduced.
  • Navigation: Using biplane fluoroscopy and contrast angiography, a microcatheter is carefully steered through the aorta, neck arteries, and cerebral vessels into the aneurysm sac.
  • Coil Deployment: Soft platinum coils (diameter 0.010–0.014 inches) are fed through the microcatheter one by one into the aneurysm. Each coil loops and compacts inside, filling the sac. The first coil frames the aneurysm; subsequent coils fill the interior.
  • Complex Cases: For wide-necked aneurysms, balloon-assisted or stent-assisted coiling techniques allow coils to be packed without prolapsing into the parent artery.
  • Completion: Once the aneurysm is densely packed and no longer filling with contrast, the catheters are removed. The patient recovers in the neuro-ICU.
img

Benefits of Aneurysm Coiling

No Open Brain Surgery

Treats the aneurysm entirely from inside the blood vessels no skull opening required.

Rapid Recovery

Most patients are discharged within 3–5 days and return to normal activities within weeks.

Evidence-Based

Supported by landmark clinical trials (ISAT, CARAT) demonstrating superior outcomes in most aneurysm types.

Effective for Complex Locations

Particularly suited for aneurysms at the skull base and posterior circulation, difficult for open surgery.

Frequently Asked Questions

Most unruptured aneurysms are discovered incidentally during MRI or CT scans performed for other reasons (e.g., headaches, migraines, trauma). A ruptured aneurysm typically presents as a sudden, extremely severe "thunderclap" headache the worst headache of one's life often accompanied by neck stiffness, nausea, and loss of consciousness.
No. The treatment decision depends on the aneurysm's size, location, shape (neck width), and the patient's overall health. Some wide-necked or complex aneurysms may require flow diverter devices (like Pipeline Embolisation Device) or surgical clipping. Some very small, incidentally found aneurysms may be managed with watchful observation and risk-factor control.
Coiling typically takes 1.5 to 3 hours depending on the aneurysm's complexity, location, and the technique required. Simple coiling of a small posterior communicating artery aneurysm may be faster, while stent-assisted coiling of a large wide-necked aneurysm takes longer.
Yes. MRI/MRA or catheter angiography follow-up is performed at 6 months, 18 months, and 3–5 years after treatment to check for any aneurysm re-growth or coil compaction. A small percentage of coiled aneurysms may require retreatment, which is usually straightforward endovascularly.
Aneurysm recanalisation (partial re-opening) occurs in approximately 15–20% of coiled aneurysms over 5–10 years due to coil compaction. Modern techniques including bioactive and hydrogel coils, and flow diverters, have reduced this rate significantly. Routine follow-up surveillance detects any changes early, and retreatment is usually safe and effective.
Book Consultation with Dr. Shetty

A brain aneurysm found? Get expert guidance.

Consult with Dr. Gurucharan S Shetty to evaluate your aneurysm and discuss the safest, most effective treatment approach for your case.

Book Appointment