Aneurysm coiling: what to expect
Endovascular Procedures: Brain Aneurysm Treatment
Aneurysm embolizations are performed in the angiography room and almost always under a general anesthetic. While the patient is lying down in the procedure table, anesthetic will be administered. During the procedure, an anaesthesiologist will always be with you. Medications are administered to ensure you’re asleep, and often anticoagulants (medication to prevent blood clots formation) are also given.
After cleaning the groin area, the surgeon will make a small stab wound and guided by ultrasound, insert a small catheter (sheath) into the femoral artery, a major artery in your groin. Sometimes we use a smaller artery in the wrist, or need to puncture both groins, depending on the type of treatment.
This will be the “working channel” used during the procedure. With the use of high-quality x-rays (biplane angiography) a longer catheter will be guided carefully to the neck to provide access to the brain blood vessels. Through this catheter we gain access to the intracranial vessels to treat your aneurysm.
Injecting a special dye through the catheter, the brain vessels will become visible in the x-ray monitor, making easier for the doctor to identify the aneurysm.
Once the aneurysm is located, a much smaller catheter is inserted and will be guided in the same manner inside the aneurysm. Multiple small coils made of a very thin platinum wire are then used to fill the aneurysm sac, with the goal of blocking the entrance of blood.
This maneuver is done in such way that the aneurysm sac will be closed but the normal blood vessel where it originates is preserved. This is important because this vessel supplies normal brain. The total length of the procedure is approximately 2 to 4 hours.
Some aneurysms are treated with the help of stents to support the coils, or special stents called flow diverters. These allow us to treat aneurysms with wide openings, that previously had to be treated with an open operation (microsurgical clipping).
Following the procedure, the patient will be transferred to the recovery room (PACU) and from there patients usually are transferred to the short stay unit (SSSU). More complex cases, or in case of any adverse event during the procedure, closer monitoring in the neurosurgery step down unit or intensive care unit (ICU) may be required.
After the procedure we remove the access from the artery in the groin, and often close the hole in the artery with special devices to seal it. Regardless, in the first 2 to 4 hours following the procedure, the patient will be asked to lay down on his back and keep the leg on the side of the puncture straight.
It is possible that the patient experiences mild tenderness or even a small lump on the area of the incision on his groin, but this is normal. If severe pain or bleeding is present the nurse should be notified.
Some nausea and headache might also be present, but medication can be prescribed. Most patients are discharged the next morning. Someone from the Neurovascular Service will see you, make sure you’re safe to go home, and discharge you. Follow up will be arranged by your doctor in the office / Neurovascular Clinic. You will be seen at regular intervals and have repeated tests (MRIs, CTs, angiograms depending on your case) to confirm that the aneurysm is closed and stable.
Before the surgery
Once you and your doctor have decided that treatment is required for the aneurysm and that the endovascular methods (coiling) is the best way to do it, the informed consent for the procedure should be signed with your doctor. It is important that you understand the treatment proposed and possible risks. Make sure you clarify with your doctor all your doubts, and that you are comfortable with the choice made.
The office will then schedule a pre-admission appointment with the anaesthesiology team, and you might have to undergo some pre-operative tests (blood test, electrocardiogram, chest x-ray). You will also be informed of the date for the procedure.
On the day of surgery
During the pre-admission appointment, you will be informed of the time you should be at the hospital. You should not eat or drink anything after midnight the night before your surgery.
For some endovascular procedures, antiplatelets (blood thinners) are required before and after the operation. You will receive a prescription from your surgeon in case you need it. It is important to take the medication without interruption, including on the day of surgery (with a sip of water only).
Once you arrive at Sunnybrook on the day of your procedure, please go to the Same Day Registration at M wing, ground floor, room 502 (MG 502). The endovascular procedures happen in the Angiography suite, M wing, Ground floor (416-480-6100, #1430). You’ll be directed there after registration is complete.
If you have a family member with you, they can stay until you’re admitted to the angiography preparation room. If they wish, they can wait outside. There is a waiting area by the entrance on M wing, ground floor (by the waterfall). Alternatively, there is a surgical waiting area on the first floor, A1-48.
After discharge
You may shower the day after or the morning of the procedure. Endovascular procedures are minimally invasive and done through one (and sometimes two) small incisions in the groin. No stitches are used in most cases, only a small dressing.
Remove the dressing 48h after the procedure. The incision site can be gently cleaned with soap and water.
Drink plenty of fluids (water, juice) but avoid alcoholic beverages. Avoid bending, lifting, driving or vigorous physical activities for at least 3 days, ideally a week.
If you have diabetes: the contrast used in the procedure can affect your kidney, especially in combination with certain diabetes medications (e.g. Metformin). Often, you’ll be asked to stop the Metformin on the day of and for 24 hours after surgery. Please check with your doctor.
Some patients have pain in the groin area for a few days. Acetaminophen or ibuprofen can be used for pain control and application of warm compresses can help with the discomfort.
If bleeding from the puncture site occurs, lay down and apply firm pressure at the puncture site. This is often enough to stop it. If the bleeding persists, or a sizable lump develops in the puncture site, or you feel lightheaded, dizzy, or faint, contact your doctor’s office and/or go to the nearest ER. Sunnybrook’s ER has neurosurgical/neurovascular coverage 24/7 and you’ll be seen even if your surgeon is away or not on call.
Learn more about the Centre for Neurovascular Intervention at Sunnybrook »
Contact the Centre: email neurovascular@sunnybrook.ca or call 416-480-6820
Sunnybrook Hospital, 2075 Bayview Avenue, Room A1-29, Toronto, ON M4N 3M5
