March 30, 2009

Intracranial Aneurysms: Coil Embolization

Fig.1 & 2: Angiographic image of the left internal caroid artery injection shows an aneurysm of the left supraclinoid internal carotid artery. Fig.1 without subtraction, Fig.2 with.
Fig.3: Angiographic image after coil embolization (performed because the patient had SAH) reveals a coil within the aneursym.

Coil Embolization Complications

  • Complicaton rate 8.6% to 18.6% (median 10.6%), lower than surgical clipping
  • Common complications: thrombo-embolic events, perforation of aneurysm, parent artery obstruction, collapsed coil, coil malposition, and coil migration
Coil Embolization versus Aneurysm Clipping
  • Less risks of death
  • Higher rate of rebleeding (2.4% versus 1%) - why*
  • Advantages vary depending on location of aneurysm, but coil embolization is beneficial for all sites
*Percentage of complete aneurysm occlusion after coil embolization is lower than with surgical clipping
* Recurrence = refilling of thee neck, sac, dome of a successfully treated aneurysm

What to Choose?
  • Not all aneurysms required coil embolization. This depends on size, anatomy and location of aneurysms.
  • People at increased risk for craniotomy (>65 years, poor clinical status, comorbid conditions)
  • Suitability depends on size, anatomy, location of aneurysms (in ophthalmic artery or basilar tip artery)
  • Better perform craniotomy if
  • >10 mm size
  • > 4mm neck

Ontario Heath Technology Advisory Committee. Coil Embolization for intracrinal aneurysms.

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