Intracranial embolization

Some brain conditions can now be treated using tiny tubes called catheters, threaded from an artery in the groin all the way to the brain. These conditions can be treated by “plugging” the condition from the inside, or blocking its blood supply. This is called “embolization.” Depending on the condition treated different materials are used for embolization. These materials include small particles, special types of glue and platinum coils. Brain conditions treated by embolization include tumors, vascular malformations and aneurysms. The most common condition is an aneurysm. This is a sometimes small blister in a brain artery that can result in fatal or debilitating bleeding.

Depending upon an aneurysm’s size, location and shape it may be possible to treat an aneurysm from inside the blood vessel. This minimally invasive procedure is very similar to a cerebral angiogram. In addition to taking pictures, a small tube called a catheter is navigated through the blood vessels and into the aneurysm itself. Then, with x-ray guidance, soft platinum micro-coils are placed into the aneurysm and detached. The coils stay within the aneurysm, sealing it off. While more complex aneurysms used to require a traditional surgical procedure requiring removal of bone, many of these aneurysms can now be treated with the use of temporary micro-balloons and permanently implanted wire mesh tubes called stents used in conjunction with micro-coils. Our experience with these advanced technologies allows us to offer this minimally invasive option to the overwhelming majority of patients with cerebral aneurysms. As a result, patients benefit from a dramatically reduced hospitalization and recovery time compared to traditional aneurysm surgery.

While traditional brain surgery remains an option for some patients with brain aneurysms, there is growing evidence that a subset of patients may do better with minimally invasive embolization. The recently concluded International Subarachnoid Aneurysm Trial (ISAT), published in the prestigious medical journal Lancet, reported a 24% relative risk reduction in patients with ruptured aneurysms undergoing embolization versus surgery. In order to determine which form of treatment is best, patients will meet both with a physician that performs embolization and a physician that performs traditional surgery. The safest and most durable form of treatment will then be offered to the patient.