Endovascular Embolization or Coiling

Endovascular treatment of aneurysms is a relatively new phenomenon originating in the 1960s.

Dr. Guido Guglielmi, an Italian doctor, and several other researchers were the visionaries behind the GDC (Guglielmi Detachable Coils) system, or coiling procedure. With the advent of this remarkable new treatment, some patients who were told they had inoperable aneurysms were now given hope and a chance for survival. Other patients, because of advanced age, serious medical problems, or other factors, could not undergo open brain surgery, so the GDC system became an alternative to their treatment.

Endovascular (meaning within the blood vessel) embolization, or coiling, uses natural access to the brain through the bloodstream via arteries to diagnose and treat brain aneurysms. The goal of the treatment is to safely seal off the aneurysm and prevent further blood from entering it, increasing the risk of rupture or possibly re-bleeding.

A small incision is made over the artery, and a needle is used to puncture the blood vessel. A sheath (hollow thin tube) is placed in the artery, providing constant access to the artery. This catheter sheath usually remains in the artery for 24 to 48 hours after the procedure, so further interventions can be performed if necessary. The artery leading to the aneurysm is selected using a catheter (hollow plastic tube) over a guiding wire. The wire is removed, and the catheter injects a contrast dye into the bloodstream to visualize the normal blood vessels and delineate the aneurysm.

The entire process uses continuous X-ray visualization and high-speed radiographic filming techniques. The doctor takes measurements and views of the aneurysm. Once the angiogram has detected the aneurysm's presence, size, and location, a smaller “micro-catheter” is placed inside the initial catheter. Once the micro-catheter is successfully navigated into the aneurysm opening, the coil system is introduced.

Platinum coils are deposited into the aneurysm, reducing or blocking blood flow. Once placed inside the aneurysm, a small electrical current is passed through the wire. As a result of this electrolysis, the coil detaches from the wire and remains inside the aneurysm. The wire is removed. It may take several coils to obliterate the aneurysm. After aneurysm packing, the catheter systems are removed, and the patient is transferred to the intensive care unit for monitoring and further care.