Cerebral Aneurysm Coiling
Endovascular treatment of intracranial aneurysms — platinum coils packed into the aneurysm sac via microcatheter under biplane fluoroscopic and 3D rotational angiography guidance. Largely replaced open surgical clipping for most aneurysms amenable to endovascular approach since the ISAT trial (2002) demonstrated better outcomes for coiling in subarachnoid hemorrhage.
Clinical pathway
- Femoral or radial access — large-bore sheath, heparinization.
- Diagnostic angiography — bilateral carotids + vertebrals, 3D rotational runs to characterize aneurysm neck, dome, daughter sacs.
- Microcatheter navigation — coaxial system advanced through guide catheter into the aneurysm sac.
- Coil deployment — detachable platinum coils sized to aneurysm; framing coil first, then filling and finishing coils.
- Adjuncts if needed — stent-assisted coiling for wide-neck aneurysms, balloon remodeling, flow diverters (Pipeline) for giant or fusiform lesions.
- Final runs + closure — document occlusion, manage access site.
Typical systems
Biplane essential — two orthogonal projections simultaneously halves procedure time, contrast, and dose compared to single-plane for a complex 3D structure.
Room + procedure characteristics
- Procedure time: 90 min to 4+ hours depending on aneurysm morphology and rupture status
- Team: neurointerventionalist + neuro anesthesia + rad tech + circulating RN; general anesthesia standard
- Imaging: 3D-DSA runs for pre-procedure planning, frequent roadmap fluoroscopy, high-magnification biplane cine
- Dose: among the highest-dose fluoroscopic procedures — careful attention to frame rate reduction, collimation, and ClarityIQ-class dose reduction meaningful
Dose considerations
Patient head dose in ruptured aneurysm cases can reach skin injury thresholds in prolonged procedures. DAP tracked per case and reported. Operator occupational dose significant due to long proximity to beam — ceiling shields and lead-acrylic barriers mandatory.