Endovascular Coiling
Make an Appointment
Coiling, also called endovascular coiling, coil placement, or coil embolization, treats brain aneurysms. Unlike traditional clipping, coiling doesn’t require an incision in the skull. Instead, your doctor threads a catheter from a blood vessel in the groin up into the blood vessels in the brain. Your doctor uses fluoroscopy (a special type of X-ray) to help move the catheter to your head and into the aneurysm.
Once the catheter is in place, your doctor moves tiny platinum coils through the catheter into the aneurysm. These soft platinum coils, which are visible on X-ray, conform to the shape of the aneurysm. The coiled aneurysm becomes clotted off (embolization), which prevents a rupture.
The Advantages of Endovascular Coiling
You can benefit from coiling, because it doesn’t require big cuts in your skull. This procedure:
- Gives you the option to sleep or stay awake during the treatment
- Does not expose you to the risks of traditional surgery
- Means a quicker and easier recovery
A Minimally Invasive Procedure
Neurosurgeon Min Park, MD, explains how the coiling procedure treats aneurysms without cutting into the skull, allowing for shorter recovery time.
The way we select patients for the coiling procedure really depends on the anatomy of the aneurysm and its relationship to the blood vessels. Certain aneurysms are more amenable to having surgical clipping while other aneurysms are more amenable to treatment with endovascular techniques such as coiling.
In that procedure, we actually go through really long small catheters and we can access either the wrist or down in the hip area and navigate catheters all the way from out in that area up to the vessels in the brain. And from there we can enter into the aneurysm and deploy tiny little platinum coils. And what they do is they fill up the aneurysm so that the blood flow can't get into it, and thus it drastically reduces the chance of having a bleeding event in the future.
For coiling, we generally like aneurysms with a small opening into the normal vessel. That allows the coils to stay into the aneurysm without risk of it falling out into the normal blood vessel which could cause problems. However, we're fortunate to have other devices such as stents or balloons that can help us keep the coils within the aneurysm, reducing the risk of any adverse events for the individual. A routine aneurysm coiling can take about two hours, maybe even a little less depending on how difficult that specific case is.
The way we are able to see what we do requires something called fluoroscopy, and that is basically live x-rays that allow us to navigate within the blood vessels, position our catheters in the proper position, and to make sure our coils or other devices like stents are going exactly where we want them to be.
We're very fortunate at the University of Virginia to have a multidisciplinary team that helps us navigate and manage patients with cerebral aneurysms. We're the only hospital in the region that offers both neurosurgeons who have been specially trained to embolize aneurysms, as well as neurointerventional radiologists.
Endovascular Coiling for Complex Cerebral Aneurysms
Some aneurysms are large or have a wider neck or opening. In these cases, inserted coils can protrude out of the aneurysm and into the blood vessel. This can lead to a stroke.
We can prevent this complication with a couple of methods:
- Balloons can hold the coils in place when inflated in your artery near the aneurysm
- Stents can cut off the flow of blood to the aneurysm while keeping coils from moving
Removable Stent Technology
Traditional stents stay in your body after a coiling procedure. At UVA, we can use a removable stent called the Comaneci device. We started using this device before anyone else in Virginia.
The Comaneci device looks like a small, rolled-up, chain-link fence. With a tiny catheter, we insert the stent through your artery to the aneurysm. Then, the device expands and creates a scaffolding that keeps the coils in place. Once the coils fill the aneurysm completely, we collapse the stent and remove it from the artery.
You must take blood thinners before the procedure, but not after. You’ll recover quickly. Most patients leave the hospital after a day.
Endovascular Coiling Alternatives
If you're not a candidate for coiling, we also offer microvascular clipping for brain aneurysms.