Cerebral Vascular Disease

An aneurysm is a small bubble that forms on the wall of an artery that carries blood to the brain. The aneurysm has a thin wall compared to a normal brain artery, making it prone to rupturing.

An aneurysm results from a weakness in the wall of a blood vessel. Most occur without any known cause, though high blood pressure and smoking are contributing factors. Some appear to have a genetic component. Other than controlling blood pressure and quitting smoking, there is little a patient can do to prevent their growth or formation.

Without multiple imaging studies showing growth over time, it’s impossible to know. It may have been present for years or only a few months.

The two main concerns are bleeding and enlargement. A ruptured aneurysm can cause bleeding in the brain known as subarachnoid hemorrhage (SAH). An enlarging aneurysm can press on the brain or nearby nerves, affecting muscles in the face, eye, or neck.

The exact risk cannot be known. Very small aneurysms (1–2 mm) appear to carry very little bleeding risk.

A bleed typically causes a sudden, extreme headache unlike any previously experienced, often accompanied by nausea and vomiting. Severe bleeding may cause loss of consciousness. In about one-third of cases, treatment leads to full recovery; another third survive but may suffer a stroke; and in the remaining third, the bleed is fatal.

Aneurysms often remain stable in size for years, but some do grow. Even aneurysms that don’t grow still carry a bleeding risk. If an aneurysm is actively growing, it will generally continue to enlarge and cause further problems.

Enlargement typically occurs slowly over weeks, months, or years. Symptoms may include decreased vision in one or both eyes, unusual headaches (often behind one eye), double vision, or weakness in the arms, legs, or hands depending on the aneurysm’s location.

No. The location, size, and shape of the aneurysm determine whether coil treatment is appropriate. The final treatment decision is based on an angiogram, as MRI and MRA are generally not reliable enough on their own.

Some wide-neck aneurysms can still be treated by placing a stent in the artery to hold the coils in place. If a stent is used, patients will need to take aspirin and Plavix before the procedure and for a directed period afterward.

The patient is placed under general anesthesia. A catheter is inserted through the leg artery and guided up to the affected brain artery. A smaller microcatheter is then navigated into the aneurysm itself, through which soft platinum coils are delivered to fill the aneurysm. Once filled, the catheters are removed and the leg artery is closed with a small suture under the skin.

Blood begins clotting on the coils within hours of placement, providing early protection against bleeding. Over the following six weeks, the clot converts to scar tissue for longer-term protection. There is a small risk of clots falling into a normal artery, but this is minimized by keeping coils well within the aneurysm.

A Pipeline Stent uses flow diversion to treat an aneurysm. It is placed in the parent artery across the aneurysm’s neck, diverting blood flow away so that blood already inside clots and turns to scar tissue. It is used for wide-neck aneurysms or those not suited for standard coil treatment. Aspirin and Plavix are required after placement.

A waiting room is available near the procedure room. Procedures typically take two to four hours. Staff will provide updates during the procedure and discuss results with family and friends upon completion if desired.

Patients wake up in the radiology department and are monitored overnight in the ICU. Getting out of bed the same day is encouraged if the leg is stable. Liquids are offered for the first meal, and patients may go home the following day if doing well. Mild headache and groin soreness are common.

Expect fatigue for several days as you recover from anesthesia. Normal activities should be resumed as soon as possible. A follow-up clinic visit is scheduled 2–3 weeks after the procedure, with earlier appointments available if needed.

Risks include causing bleeding from the aneurysm, blocking normal brain blood vessels leading to stroke, or incompletely treating the aneurysm. Additional risks associated with the angiogram include allergic reaction, bleeding, stroke, and in rare cases, death. Treatment is recommended when the risks of leaving the aneurysm untreated are considered greater than the risks of the procedure.

A follow-up angiogram is typically recommended six months after treatment, with additional imaging at 1, 2, and 5 years. This schedule may be adjusted based on age, medical history, or individual circumstances.

Coil treatment was first described around 1990, replacing earlier balloon-based techniques that had been used primarily in the Soviet Union.

The coils are made from platinum, which is permanent, biologically stable, and does not cause allergic reactions. MRIs remain safe with platinum coils in place, though CT scans may show some artifact. Stents are made from a similarly stable metal.

Yes. Surgery involving placement of a clip on the aneurysm from outside the blood vessel is an alternative. Some aneurysms are better suited to surgery, others to coiling, and in some difficult cases observation may be the recommended approach. The final decision rests with the patient and their family.

About 10% of patients have multiple aneurysms. These may be treated with coils or surgery, or monitored by MRI or MRA if they are small.

Yes. Many medical device companies are developing new therapies utilizing stents, glues, and new types of coils.

A cerebral angiogram is a study used to examine the blood vessels in the head and neck, performed in the radiology department at Sacred Heart Medical Center. It is normally an outpatient procedure, with admission in the morning and discharge in the afternoon. Most angiograms take about an hour, occasionally longer.

Upon arrival, you will be given a hospital gown and an IV line will be inserted in your arm to administer relaxation medication and fluids. You will lie on a cushioned x-ray table with monitoring devices attached to measure heart rate, blood pressure, and breathing. The groin area will be shaved, cleaned, and covered with a sterile drape, and a local anesthetic will be applied — causing brief stinging similar to a dentist’s office that fades within 15 seconds. A small catheter is then inserted through the groin artery and guided by x-ray up to the neck. There are no nerves in these arteries, so you will feel no sensation from the catheter’s movement. Once positioned, contrast dye is injected and x-ray images are taken. You may feel a warm sensation on one side of your face or briefly see flashing lights in one eye — both are normal reactions to the dye. Image captures last about 10 seconds each, during which you will be asked to hold your breath and stay still.

Family and friends may accompany you to the interventional holding area before the procedure. A waiting area is available near the angiography suites during the procedure, and progress updates can be sent to them upon request. Results can also be discussed with family afterward if you wish.

The catheter is painlessly removed and pressure is applied to the insertion site for about 15 minutes, or a dissolvable suture is placed. You will need to lie flat and keep your leg straight for 2 hours if a suture was used, or 4–6 hours if not. You may eat and should drink plenty of fluids. Once the waiting period is complete and you are feeling well, you may go home — though someone else must drive you. After discharge, avoid heavy lifting for 48 hours and strenuous activity such as running, biking, or weightlifting for three days. Driving may resume the next day if you feel fully recovered. A small lump at the groin site is common and normal, but should be evaluated if it grows. Some minor hair loss near the site may occur and is temporary, though it can take up to six months to fully grow back.

The overall risk is extremely small, but risks do exist. These include a rare but potentially life-threatening allergic reaction to the contrast dye, kidney damage from the contrast, stroke caused by vessel damage during catheter placement, and bleeding at the groin puncture site. If you have previously had an allergic reaction to iodine-based contrast dyes, notify your care team in advance so preventive treatment with steroids and antihistamines can be arranged. Your doctors have determined that the benefit of the information gained from this procedure outweighs these risks.

Results are typically available immediately after the procedure and will be discussed with you once you are fully awake. Selected images may be provided in some cases, and a follow-up clinic visit can be arranged to review the findings in more detail.