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.