Brain Aneurysm Stenting

What is a Wide-Necked Brain Aneurysm?

A brain aneurysm, also called a cerebral or intracranial aneurysm, is an abnormal bulging outward of one of the arteries in the brain. Wide-necked aneurysms are characterized by a large opening to the blood vessel on which they formed. This opening is called the aneurysm neck. It is estimated that up to one in 15 people in the United States will develop a brain aneurysm during their lifetime.

Brain aneurysms are often discovered when they rupture, causing bleeding into the brain or the space closely surrounding the brain called the subarachnoid space, causing a subarachnoid hemorrhage. Subarachnoid hemorrhage from a ruptured brain aneurysm can lead to a hemorrhagic stroke, brain damage and death.

The main goals of treatment once an aneurysm has ruptured are to stop the bleeding and potential permanent damage to the brain and to reduce the risk of recurrence. Unruptured brain aneurysms are sometimes treated to prevent rupture.

Treatment of Wide-Necked Brain Aneurysms

Surgery or minimally-invasive endovascular coiling techniques can be used in the treatment of brain aneurysms. It is important to note, however, that not all aneurysms are treated at the time of diagnosis or are amenable to both forms of treatment. Patients need to consult a neurovascular specialist to determine if they are candidates for either treatment.

Surgical Treatment
To get to the aneurysm, surgeons must first remove a section of the skull, a procedure called a craniotomy. The surgeon then spreads the brain tissue apart and places a tiny metal clip across the neck of the aneurysm to stop blood flow into the aneurysm. After clipping the aneurysm, the bone is secured in its original place, and the wound is closed.

Minimally-Invasive Treatment
Brain Aneurysm Stenting with Coil Embolization or Endovascular Coiling
Endovascular therapy is a minimally invasive procedure that accesses the treatment area from within the blood vessel. In the case of aneurysms, this treatment is called coil embolization, or "coiling". In contrast to surgery, endovascular coiling does not require open surgery. Instead, physicians use real-time X-ray technology, called fluoroscopic imaging, to visualize the patient's vascular system and treat the disease from inside the blood vessel.

Small, flexible, tube-like devices called stents are used in conjunction with coiling to treat wide-necked aneurysms. The large opening of a wide-necked aneurysm makes it prone to coil herniation, or displacement of coils from the aneurysm into the parent blood vessel. Coil herniation may cause serious complications. Brain aneurysm stenting is intended to help hold the coils within the aneurysm to prevent coil herniation.

Endovascular treatment of wide-necked brain aneurysms involves insertion of a catheter (small plastic tube) into the femoral artery in the patient's leg and navigating it through the vascular system, into the head and into the aneurysm. A stent is placed across the aneurysm neck to keep coils inside the wide-necked brain aneurysm during treatment.

Another catheter is then navigated through the deployed stent and into the aneurysm. Tiny platinum coils are threaded through the catheter and deployed into the aneurysm, blocking blood flow into the aneurysm and preventing rupture. The coils are made of platinum so that they can be visible via X-ray and be flexible enough to conform to the aneurysm shape. This endovascular coiling, or filling, of the aneurysm is called embolization and can be performed under general anesthesia or light sedation.