Endovascular Treatment of Aneurysms
Brain aneurysms can be a serious concern due to their potential to rupture, resulting in debilitating or even fatal brain damage. The endovascular approach to treating brain aneurysm involves a minimally invasive technique to access the aneurysm from within the blood vessels. This article will explore what this treatment option entails, covering its advantages, potential hazards, and long-term expectations post-treatment.
What Is Endovascular Treatment of Aneurysms?
A brain aneurysm is a sac-like bulge that forms on the wall of a blood vessel. Over time, the pressure of blood flowing through the artery can cause weak spots in the vessel to expand, creating this bulge. The most serious complication of an aneurysm is rupture, which can lead to life-threatening bleeding.
There are two main approaches to treating brain aneurysms: open surgery and endovascular treatment. Endovascular treatment involves guiding a thin tube through a blood vessel in the leg or arm to treat the aneurysm in the brain.
Figure 1: Coiling of an aneurysm (Credit: Yuriy Kulikov).
Once the aneurysm is reached, platinum coils or stents may be used to occlude the aneurysm. Coiling involves the placement of small loops of platinum metal into the aneurysm sac. The presence of the platinum coils causes the aneurysm to clot off, preventing blood from entering the aneurysm.
Alternatively, a device called a flow diverter stent may be used to cover the neck of the aneurysm. This diverts blood away from the aneurysm, allowing the aneurysm to be cut off from blood circulation.
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Figure 2: Flow diverter stent for an aneurysm (Credit: Yuriy Kulikov).
The decision to use coils or a stenting technique is based on individual characteristics of the aneurysm, including its size, shape, and location. In some instances, a combination of both techniques may be used. Other devices may be utilized depending on the case and what is available at each institution, but all tools will have the same goal of effectively removing the aneurysm from circulation.
Endovascular treatment for brain aneurysm is becoming increasingly popular because it is a safe, generally effective treatment and less invasive than open surgery. However, the durability of endovascular treatment appears less than that of the clipping technique used in open surgery, and re-treatment may be required in the future.
How Are The Blood Vessels of The Brain Accessed?
To reach the major blood vessels in the brain, doctors have two primary options: the radial pathway (through the wrist) and the femoral pathway (through the groin).
Each pathway has its own advantages and considerations. The radial pathway through the wrist offers faster recovery, less bleeding, and a lower risk of complications such as infection compared to the femoral pathway. However, the radial pathway has size limitations and may not be suitable for everyone.
On the other hand, the femoral pathway through the groin allows for the use of larger catheters, which can be beneficial for complex procedures. However, it may involve a slightly longer recovery period and carries a small risk of bleeding or infection at the puncture site.
The choice of pathway depends on various factors, including the specific procedure, the individual patient condition, and the expertise of the medical team. The medical professionals involved will assess the situation and determine the most appropriate pathway to safely access the major blood vessels in the brain.
What Can I Expect During Endovascular Treatment?
Endovascular treatment for brain aneurysms is less invasive than open surgery, meaning it takes less time and has a quicker recovery. In most cases, patients can go home the next day after a short observation period. While less invasive, endovascular treatment still carries risks.
The most serious complications include bleeding from the aneurysm or having a stroke during the procedure, which, though rare, can cause serious or even life-threatening brain damage. It’s important to discuss any concerns with your surgeon before treatment.
Outcomes: Open vs. Endovascular Treatment for Aneurysms
The main goal of treating a brain aneurysm is to permanently close off the aneurysm to prevent it from rupturing in the future. In more than 80% of cases, treatment is successful. Compared to open surgery over the long term, endovascular treatment has a slightly higher chance of recurrence or re-rupture.
Endovascular treatment is often the first choice for appropriately selected aneurysms, given the typically short recovery compared to open surgery. In the long run, patients treated with either method—endovascular or open surgery—tend to have similar health outcomes and life expectancy.
Recurrence after endovascular treatment can usually be treated again, with another endovascular procedure or with open surgery. For most patients treated for unruptured aneurysms, life expectancy is not affected, and they can return to their normal activities. For patients treated after a rupture, recovery may take longer due to the damage caused by the initial bleed.
To make sure the aneurysm doesn’t come back, patients will likely have regular brain imaging tests for several years. It’s safe to have an MRI with devices like stents and coils used in endovascular treatments, but you should always inform the care team performing the study. You’ll also have no problems with airport security or metal detectors after treatment.
Key Takeaways
- Endovascular treatment of brain aneurysms is a minimally invasive technique that involves the insertion of a wire and catheter into blood vessels located in your arm or leg, thus allowing access to blood vessels in the brain.
- Endovascular therapy is an effective treatment of brain aneurysms, although it does have rare, potentially disabling and even fatal complications.
- Patients treated with endovascular techniques have a quicker and easier recovery than those treated with open surgery, but endovascular treatment does carry a higher rate of recurrence compared with open surgery.
