What is endovascular coiling?

Endovascular coiling is a procedure that blocks blood flow into an aneurysm. This procedure is also called endovascular embolization. An aneurysm is a weakened area in the wall of an artery. If an aneurysm breaks open (ruptures), it can cause life-threatening bleeding and brain damage. Preventing blood flow into an aneurysm helps to keep it from rupturing.

For endovascular coiling, the doctor puts a long, thin tube (catheter) into a groin artery. The doctor moves the catheter into the affected brain artery and puts the coil in place. X-rays help guide the catheter into the artery. The coils are made of soft platinum metal and are shaped like a spring. The coils are very small and thin. They range in size from about twice the width of a human hair to less than one hair's width. Sometimes coils are used with stents to prevent the coils from moving out of the aneurysm.

Doctors also use coiling to treat a condition called arteriovenous malformation (AVM). An AVM is a tangling of blood vessels that cause an abnormal link between an artery and a vein. It may happen in the brain, spinal cord, or elsewhere in the body.

Why might you need endovascular coiling?

Doctors mainly use coiling to treat a cerebral aneurysm at risk for rupturing. In some cases, they may use it to fix a ruptured aneurysm.

There may be other reasons for your doctor to advise a coiling procedure.

What are the risks of endovascular coiling?

If you are pregnant or think you may be pregnant, tell your doctor.

There is a risk for allergic reaction to the dye that's used to see the aneurysm on an X-ray. Tell the doctor or technologist if you are allergic to or sensitive to medicines, contrast dye, or iodine. Also tell the doctor if you have kidney failure or other kidney problems.

Also tell your doctor if you take anticoagulant (blood-thinning) medicines, such as aspirin, warfarin, or clopidogrel. You may need to stop taking these medicines for one or more days before the procedure to prevent bleeding.

Because the procedure involves the blood vessels and blood flow of the brain, there is a risk for problems involving the brain. These problems may include:

• The coils poking through the aneurysm or a blood vessel.

• Loss of consciousness.

• Stroke or mini-stroke (transient ischemic attack). This can be from a blood clot or a coil moving into the wrong artery.

• Paralysis of one-half of the body.

• Blood clot.

• Bleeding.

• Area of swelling caused by a collection of blood (hematoma).

• Loss of the ability to speak or understand speech (aphasia).

• Infection.

• Rupture of aneurysm.

• Higher chance of an aneurysm returning.

• Blood collection (hematoma) in your groin, where the catheter was inserted.

You may have other risks depending on your specific health condition. Discuss any concerns with your doctor before the procedure.

How do you get ready for an endovascular coiling?

• Your doctor will tell you about the procedure and offer you a chance to ask any questions.

• You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully, and ask questions if something isn't clear.

• Tell your doctor if you have ever had a reaction to any contrast dye or if you are allergic to iodine.

• Tell your doctor if you are sensitive to or are allergic to any medicines, latex, tape, or anesthetic medicines (local and general).

• Follow any directions you are given for not eating or drinking before surgery.

• Tell your doctor if you are pregnant or think you may be pregnant.

• Tell your doctor about all the prescription and over-the-counter medicines and herbal supplements that you are taking.

• Tell your doctor if you have a history of bleeding disorders. Also tell your doctor if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. You may need to stop taking these medicines before the procedure.

• Your doctor may order a blood test before the procedure to find out how long it takes your blood to clot. Other blood tests may be done as well.

• Based on your health condition, your doctor may give you other instructions.

What happens during an endovascular coiling?

You will need to stay in the hospital for a coiling procedure. Procedures may vary depending on your condition and your doctor's practices.

Your procedure may be done by one or both of these specialists:

• Neurosurgeon. This doctor specializes in surgery and treatment of the nervous system.

• Interventional radiologist. This doctor specializes in diagnostic and treatment methods using radiology techniques.

During the procedure, you are asleep under general anesthesia. In some situations, it may be done under local anesthesia.

Generally, a coiling procedure follows this process:

1. You will be asked to remove any clothing, jewelry, hairpins, dentures, or other objects that may interfere with the procedure. You will be given a hospital gown to wear.

2. You will be given time to empty your bladder before the start of the procedure.

3. You will be positioned on your back on the X-ray table.

4. An I.V. (intravenous) line will be started in your hand or arm.

5. You will be connected to an electrocardiogram (ECG) monitor that records the electrical activity of the heart. Your heart rate, blood pressure, breathing rate, and nervous system signs will be monitored during the procedure.

6. A catheter may be put into your bladder to drain urine.

7. The radiologist or neurosurgeon will check your pulses below the groin site where the catheter will be inserted. The doctor will mark them with a marker so that the circulation to the limb below the site can be checked after the procedure.

8. The care team will clean the skin over the injection site. You will be given a local anesthetic.

9. The doctor will make a small cut (incision) in the skin to expose the artery in the groin.

10. The doctor will put a catheter into the artery in your groin using a guide wire. The catheter will be guided through the blood vessel into the brain using fluoroscopy. This is a special type of X-ray, similar to an X-ray "movie."

11. When the catheter reaches the affected artery in the brain, contrast dye will be injected to make the aneurysm and surrounding blood vessels visible on X-ray.

12. The doctor will measure the aneurysm and record its shape and other aspects.

13. The doctor will put a smaller catheter into the initial catheter.

14. When the catheter has reached the aneurysm, the doctor will move the coil into the aneurysm.

15. When the coil has been completely placed into the aneurysm, the coil is released from the catheter.

16. The doctor will put in as many coils as needed to completely seal off the aneurysm. The coils will form a mesh-like structure inside the aneurysm.

17. After the aneurysm has been "packed" with coils, more X-ray images will be taken to make sure the aneurysm has been sealed off. The coil is left in place in the aneurysm.

18. When the aneurysm has been sealed off, the catheter will be removed. After the insertion site stops bleeding, a dressing will be applied.

What happens after an endovascular coiling?

Next steps

Before you agree to the test or the procedure, make sure you know:

• The name of the test or procedure.

• The reason you are having the test or procedure.

• What results to expect and what they mean.

• The risks and benefits of the test or procedure.

• What the possible side effects or complications are.

• When and where you are to have the test or procedure.

• Who will do the test or procedure and what that person’s qualifications are.

• What would happen if you did not have the test or procedure.

• Any other tests or procedures to think about.

• When and how you will get the results.

• Who to call after the test or procedure if you have questions or problems.

• How much you will have to pay for the test or procedure.