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Coil Embolization
Endovascular therapy is a minimally invasive
way to diagnose and treat a patient from within a blood vessel. In the
case of a brain aneurysm, this treatment is called coil embolization, or
"coiling." Coiling does not require open surgery. Instead, physicians
use real-time X-ray technology, called fluoroscopic imaging, to
visualize the patient's vascular system and treat the disease from
inside the blood vessel.
Advanced Technology, Available Locally
More than 125,000 patients worldwide have been treated with detachable
platinum coils. Only a handful of hospitals in the United States have
the available technology to offer coil embolization. OSF St. Joseph
Medical Center is one of only two hospitals between Chicago and St.
Louis currently offering this procedure.
Minimally Invasive
Coiling involves insertion of a catheter into the femoral artery in the
patient's leg and navigating the catheter through the vascular system
into the patient’s head and to the aneurysm. The entire process is done
using continual X-ray visualization and high-speed radiographic filming
techniques. Once the physician has detected the presence, size, and
location of the aneurysm, a smaller "microcatheter" is then placed
inside the initial catheter. When the microcatheter has been
successfully navigated into the aneurysm opening, the coiling system is
introduced. Platinum coils are
deposited into the aneurysm, reducing or blocking the flow of blood to
the aneurysm. The coils are made of platinum so they are visible via
X-ray and are flexible enough to conform to the aneurysm’s shape. The
goal of coiling is to pack the aneurysm tightly to close off the flow of
blood to the aneurysm, thereby preventing its rupture. 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.
After aneurysm has been packed, the catheters are removed and the
patient is transferred to Intensive Care for monitoring and further
care. Coiling procedures are
performed under general anesthesia.
After the Procedure
Patients who have the coiling procedure done before an aneurysm ruptures
can expect to spend the night in Intensive Care for monitoring.
Typically, they do not experience pain or scarring as a result of the
coiling procedure.
Patients with a ruptured aneurysm have a longer stay in Intensive Care,
typically 10 to 14 days.
Cheryl Shepherd
“I was working out with my sister-in-law one morning, just like we do
every day,” says Cheryl Shepherd of Heyworth, IL. “All of the sudden I
felt really lightheaded and dizzy. I couldn’t move my neck and my head
hurt so badly. My sister-in-law called 911.”
Ms. Shepherd was diagnosed with an aneurysm
- an aneurysm that could not be treated with traditional “clipping”
methods. The quarter-sized bleed was located too close to her brain stem
for clipping to be an option.
Fortunately, OSF St. Joseph Medical Center’s Endovascular Surgical
Neuroradiology team was just a short ambulance ride away. Cheryl spent
the next several hours in surgery, where neuroradiologist Ajeet Gordhan,
MD worked to place 16 coils in Cheryl’s aneurysm.
While recovery has been slow, Cheryl continues to improve. “I am back to
walking by myself. I still have a hard time with my vision, but that is
getting better all the time,” says Cheryl. “I am alive today because of
Dr. Gordhan and the coil embolization procedure. Had that technology not
been immediately available, I would not be here now.”
When Time is Critical, Experience Matters
When a patient is diagnosed with a brain aneurysm, time is critical.
Mortality and morbidity are 50 percent after the first rupture of an
aneurysm and 75 percent after a second rupture. When your patient is in
need of treatment, the OSF St. Joseph team is immediately available with
the experience and expertise you expect.
Florence Birkey
“My hand went completely numb. I couldn’t think or talk. I thought I was
having a stoke,” says Florence Birkey. “I immediately went to the
hospital and was referred to OSF St. Joseph Medical Center.”
Florence was taken right to surgery. Her
aneurysm had started to bleed. Dr. Gordhan and his team placed five
coils in Florence’s aneurysm. “I wasn’t expected to live,” says
Florence. “But by the grace of God I am here today.”
“Dr. Gordhan and the entire team at OSF St.
Joseph Medical Center took the time to help me understand everything.
They were all so patient. Dr. Gordhan said he would stay by my side
until I felt comfortable with all of the information he was giving me.
And he did.”
Better Patient Outcomes
Studies comparing endovascular coiling and surgical treatment of
unruptured aneurysms have found that endovascular coiling is associated
with shorter hospital stays and shorter recovery times.
In addition, research has shown that for
patients equally suited for both open surgery and coiling, endovascular
coiling treatment produces substantially better patient outcomes than
surgery in terms of survival free of disability at one year. The
relative risk of death or significant disability at one year for
patients treated with coils was 22.6 percent lower than in
surgically-treated patients*.
Lois Ard
“I went to the hospital with a severe headache,” says Lois Ard. “I felt
so sick. The doctors and nurses there told me right away that I needed
to go to OSF St. Joseph Medical Center.”
Fortunately, Ms. Ard’s aneurysm had not
ruptured. She was in surgery for about seven hours and had several coils
placed. She stayed at OSF St. Joseph Medical Center for five days for
monitoring and follow-up care before returning home to Champaign, IL. “I
had no pain or scaring from the procedure. I still follow up with Dr. Gordhan periodically. I just couldn’t say enough about him or the team
at OSF St. Joseph Medical Center.”
Keeping You Informed: A note to referring physicians
When you refer your patient to OSF St. Joseph Medical Center, you remain
an integral part of your patient’s treatment team. Our endovascular
surgery team keeps you informed of your patient’s procedure and outcomes
throughout the patient’s stay. For
more information about coiling services for your patient, please call
Endovascular Surgical Neuroradiology at OSF St. Joseph Medical Center at
309-665-4780.
*Molyneux A, Kerr R, Stratton I,
Sandercock P, Clarke M, Shrimpton J, Holman R. International
Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus
endovascular coiling in 2143 patients with ruptured intracranial
aneurysms: a randomized trial. Lancet. 2002: 360: 1267-74.
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