Minimally Invasive Procedures

Aneurysm embolization

Depending upon an aneurysm’s size, location and shape it may be possible to treat an aneurysm from inside the blood vessel. This minimally invasive procedure is very similar to a cerebral angiogram. A small tube called a catheter is navigated from an artery in the groin and into the aneurysm itself. Once there, the aneurysm can be treated via several methods. All of these methods are performed in a minimally invasive fashion, via a very small incision in the groin.

In the coiling procedure, soft platinum micro-coils are placed into the aneurysm and detached. The coils stay within the aneurysm, blocking it off from the blood stream by direct occlusion and by promoting clotting of the aneurysm.

In the liquid embolic procedure, a glue like substance is injected through the catheter and into the aneurysm. The goal of this procedure is completely obliterate the aneurysm by filling it with the glue like material. The first liquid embolic material approved by the FDA for aneurysm embolization wa onyx HD-500, approved in the United States in 2006. A Los Angeles Brain and Spine Institute physician performed the first FDA approved liquid embolization of a cerebral aneurysm on the west coast of the U.S. in September, 2008.

Sometimes, more complex aneurysms may require multiple treatments using several recently developed adjuncts. These techniques are usually used for the treatment of wide-necked aneurysms. Wide necked aneurysms are complex because the opening, or neck, of the aneurysm may be so large that coils or other embolic material may migrate from the aneurysm into the normal arter.

In the balloon remodeling technique, a balloon is placed across the site where the aneurysm originates from the cerebral blood vessel. Through a second catheter in the aneurysm coils or liquid embolic material are inserted. The balloon is temporarily inflated during coil or liquid embolic placement and keeps the treatment material in the aneurysm and away from the normal artery.

Sometimes, wire mesh tubes, called stents, are inserted into the artery harboring the aneurysm. The stent is placed across the aneurysm opening. Stenting can be used in several ways. When used as an adjunct to the coiling procedure, the stent is used to create a mesh network across the opening of the aneurysm. This mesh network allows more precise coil placement into wide necked aneurysms and keeps coils from entering the normal artery.

While more complex aneurysms used to require a traditional surgical procedure requiring removal of bone, many of these aneurysms can now be treated with the use of the advanced procedures described here. Our experience with these advanced technologies allows us to offer this minimally invasive option to the overwhelming majority of patients with cerebral aneurysms. As a result, patients benefit from a dramatically reduced hospitalization and recovery time compared to traditional aneurysm surgery.

While traditional brain surgery remains an option for some patients with brain aneurysms, there is growing evidence that a subset of patients may do better with minimally invasive embolization. The recently concluded International Subarachnoid Aneurysm Trial (ISAT), published in the prestigious medical journal Lancet, reported a 24% relative risk reduction in patients with ruptured aneurysms undergoing embolization versus surgery.

For aneurysms that haven’t bled, embolization is carried out under general anesthesia. The patient will remain in the hospital for one to several days. For aneurysms that have bled, causing a subarachnoid hemorrhage, the patient may remain in the hospital for weeks, until there has been stabilization and recovery from the hemorrhage.