What is Coil Embolisation?
Coil embolisation, also referred to as endovascular embolisation or coiling, is a minimally invasive surgical procedure to treat an aneurysm in the brain by filling the aneurysm with tiny titanium coils and stopping blood from flowing into it.
An aneurysm is a weakened section in the wall of an artery that causes bulging, dilation, or ballooning of the artery. A brain aneurysm is the ballooning of a weak area on the wall of an artery in the brain. If an aneurysm ruptures, it can cause potentially fatal bleeding and brain damage. Blocking or preventing blood flow into an aneurysm in the brain helps to keep it from rupturing.
During coil embolisation, a thin, long, flexible tube called a catheter is passed through an artery (endovascular) in the groin up into the area of aneurysm in the brain using real-time X-ray technology, called fluoroscopic imaging. Tiny, soft, spring-shaped platinum metal coils are then delivered inside the aneurysm. These tiny metal coils induce clotting (embolisation) of the aneurysm. This assists to block blood flow and prevent rupturing of the aneurysm.
Indications for Coil Embolisation
Coil embolisation is mostly indicated as a treatment measure for a brain aneurysm at risk of rupturing. In some instances, the procedure may also be recommended to repair a ruptured aneurysm. Also, there may be other reasons for your surgeon to recommend a coiling procedure.
In general, your surgeon may recommend coil embolisation for individuals who do not wish to undergo open surgery (a procedure in which a small section of the skull bone is surgically removed to access the aneurysm in the brain), patients who are older and weak and cannot undergo open surgery, or patients who are not a candidate for open surgery due to other comorbidities.
Preparation for Coil Embolisation
Preparation for coil embolisation surgery may involve the following steps:
- A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anaesthesia, contrast dye, or latex.
- You should also inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
- You may be asked to stop taking blood-thinners, anti-inflammatories, aspirin, or other supplements for a week or two.
- You should not consume any solids or liquids at least 6 hours prior to the procedure.
- Arrange for someone to drive you home after the procedure as you may not be fit enough to drive yourself.
- Written consent will be obtained from you after the procedure has been explained in detail.
Procedure for Coil Embolisation
In general, coil embolisation procedure is performed under general anaesthesia and will involve the following steps:
- You will lie on your back on the operating table and the groin area is shaved and cleaned with an antiseptic solution.
- A small surgical cut is made in the groin area and a needle is used to make a hole in the femoral artery (a large blood vessel).
- Under fluoroscopic (live X-ray) guidance, a small catheter is passed through the open skin and into the femoral artery and advanced into the area of aneurysm in the brain using a guidewire.
- Once the catheter has been guided to the site of the aneurysm, contrast dye is injected through the catheter so that the aneurysm and the surrounding blood vessels are clearly visible on X-ray images.
- The aneurysm is studied and its shape, size, and other characteristics are recorded.
- A smaller catheter (microcatheter) is then inserted into the initial catheter and guided into the aneurysm opening and tiny platinum coils attached to the microcatheter are released into the aneurysm to completely seal off the aneurysm opening.
- The main objective of coiling is to pack the aneurysm firmly to close off the flow of blood to the aneurysm, thereby preventing its rupture.
- After the coils are placed inside the aneurysm, an electrical current is utilised to separate the coil from the catheter. The coil is left in place permanently in the aneurysm.
- After the aneurysm has been "packed" with coils, additional X-ray images are taken to ensure the aneurysm has been sealed off completely.
- Finally, the guidewire and the catheters are removed, and the incision site in the groin is closed with a pressure dressing.
Post-Operative Care and Recovery
Following the surgery, you will be taken to the recovery room where you will be closely monitored until your stay. You may experience pain or discomfort for which your surgeon will prescribe medications. You will also be given blood-thinning medications to prevent blood clot formation. You will be allowed to go home in a day or two after surgery. You can resume your normal activities and return to work within a couple of weeks after surgery. Refrain from strenuous activities and lifting heavy weights for a defined period. Keep your surgical site clean and dry. Instructions on surgical site care and bathing will be provided. Take all your prescribed medications and make a few lifestyle changes, such as quitting smoking and exercising regularly. A periodic follow-up appointment will be scheduled to monitor your progress.
Benefits of Coil Embolisation
Some of the benefits of coil embolisation procedure over traditional open surgery include:
- Shorter hospital stay
- Faster recovery
- Minimal muscle trauma, just a small nick on the groin skin
- Smaller to no visible scar
- Less bleeding
- Decreased risk of infection
- Less postoperative pain
- Quicker return to normal activities
Risks and Complications
Coil embolisation is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Blood clots
- Allergic/anaesthetic reactions
- Damage to adjacent tissues or organs
- Rupture of unruptured aneurysm