Cerebral Aneurysm Embolization
Cerebral aneurysm is an abnormal dilatation located at a certain point of weakness in the arteries that supply the brain. At some point, the aneurysm may rupture, leading to diffuse cerebral bleeding with serious consequences for the patient, that is, a high risk of death or disabling and permanent neurological sequelae.
Cerebral aneurysm embolization is currently the treatment of choice for most aneurysms. It is a minimally invasive technique where it is possible to treat this disease without the need to open the patient’s head (craniotomy).
It is a procedure performed in a hemodynamics room and consists of selective occlusion of the cerebral aneurysm with platinum coils, stents and remodeling balloons.
Cerebral aneurysms are usually asymptomatic and silent, manifesting only after rupture with consequent cerebral hemorrhage. Subarachnoid hemorrhage (hemorrhage resulting from the rupture of a cerebral aneurysm) is an extremely serious condition, with a mortality rate close to 40%, and most patients who survive are left with potentially serious and disabling sequelae.
Some unruptured aneurysms, that is, which have not yet bled, can give symptoms such as headaches, visual changes and dizziness.
Cerebral aneurysm embolization is indicated when there is a need to treat the lesion. The ideal is always to treat the aneurysm before it ruptures (bleeding). Currently, with the advancement of the endovascular technique (embolization) and the improvement of the materials available for occlusion of the aneurysmal sac, the vast majority of brain aneurysms are amenable to treatment using this minimally invasive technique.
The indication for treatment of unruptured brain aneurysms must be individualized and take into account several characteristics of the lesion (size, location, growth, irregularity of the aneurysm wall, contrast uptake in the aneurysm wall, etc.) and family member of cerebral aneurysm, symptoms presented by the patient, smoking, arterial hypertension and other comorbidities).
Ruptured aneurysms, that is, those that bled, must be treated urgently due to the risk of rebleeding, which can increase mortality by up to 80%.
Cerebral aneurysm embolization is a minimally invasive technique where it is not necessary to open the patient’s skull to treat the lesion. The surgery is performed endovascularly, that is, inside the arteries. To do this, it is necessary to perform a puncture of an artery in the patient’s leg, at the level of the groin (femoral artery) or in the arm (radial or brachial artery) and take a microcatheter to the region of the aneurysm and then perform its occlusion.
To perform the occlusion of the aneurysmal sac, we can use platinum microcoils (coils), stent, balloon, or in more complex cases, it may be necessary to use all these materials in the same surgery.
There are several types of coils, stents and balloons available and the choice of the most appropriate material will depend on the characteristics of the aneurysm and the patient, therefore, the choice of the best embolization technique is individualized.
It is worth mentioning that because it is a minimally invasive surgery, the patient’s recovery time is shorter compared to open surgery and in cases of aneurysms that did not bleed, the patient is discharged from the hospital in 24 to 48 hours after the surgery and can return to their activities. daily in less than a week.
No surgical incision is needed, just a small hole in the skin that doesn’t need special dressings.
Can all aneurysms be treated by embolization?
Currently, with the progressive advancement of the endovascular technique (embolization) and the continuous improvement of the materials available for occlusion of cerebral aneurysms, most of these lesions can be safely and effectively treated endovascularly.
Which stent is best?
In general, there is no best type of stent, but the most appropriate stent for the type of aneurysm presented by the patient, treatment must be individualized. There are even cases where it is not even necessary to use this device.
What are the risks of cerebral aneurysm embolization?
The main risks of embolization include stroke, rupture of the aneurysm during the procedure, and complications from the arterial puncture site.
In general, any type of treatment should only be performed when the risk of aneurysm rupture is greater than the risks of the procedure itself.
What type of anesthesia is needed for embolization of brain aneurysms?
Embolization of brain aneurysms is usually performed under general anesthesia.
Do I need to have control cerebral angiography every year after embolization?
No, the quantity and intervals of control angiograms after embolization will be determined according to the technique and materials used in the treatment of the aneurysm. In many cases only a control cerebral angiography is necessary.
