Treating Brain Aneurysms: Clipping vs. Coiling

Some 6 million people in the United States have unruptured brain aneurysms, according to The Brain Aneurysm Foundation.

That’s about one in 50 people. And every 18 minutes, one of those aneurysms ruptures.

An aneurysm happens when an artery that supplies blood to the brain weakens and bulges. When one of these arterial bulges bursts, doctors refer to it as an aneurysmal subarachnoid hemorrhage. The rupture spills blood into the subarachnoid spaces of the brain and causes a hemorrhagic stroke.

Without quick intervention, brain damage or death may be imminent, depending on how severe the hemorrhage, or blood loss, is.

Most brain aneurysms, however, don’t rupture, create health problems or cause any symptoms. They’re often only discovered when you’re being treated for an unrelated condition. An unruptured aneurysm may simply require observation. In some cases, treatment may be recommended to avert a future rupture.

How an aneurysm is treated depends on its size, location and shape, explained Augusto Elias, MD, a neurointerventional radiologist with Clinical Radiologists, S.C., who leads the neurointerventional team in Memorial Medical Center’s Stroke Center.

Dr. Elias says two procedures are common treatments for brain aneurysms: surgical clipping and endovascular coiling.

In the clipping procedure, a neurosurgeon places a clip at the base of the aneurysm to keep blood from flowing into it–sort of like tightly fastening a clothespin on a balloon’s neck to prevent more air from entering the balloon and causing it to pop.

However, clipping is an invasive procedure that requires the surgeon to make an opening in the skull and cut through the brain to reach the aneurysm. Patients typically spend four to five days in the hospital.

A less-invasive alternative is coiling in which a catheter is inserted into a groin artery and is carefully guided to the affected area of the brain. Coils are curled into the aneurysm via the catheter, filling it up until blood can no longer flow inside it. Most patients go home the day after surgery and resume their normal activities within a day.

Surgical clipping was the traditional method about 20 to 30 years ago, Dr. Elias said, but endovascular techniques have been favored over the last 15 years. Today, about 60 percent of aneurysms are coiled and 40 percent clipped. The advantages to coiling include quicker recovery, fewer fatalities, fewer complications and less pain after surgery, he said.

The average coiling procedure lasts about two hours.

Dr. Elias, neurointerventional radiologist with Clinical Radiologists, S.C., in Springfield, offers treatment in the acute setting and also offers a clinic to see patients in the non-acute setting.  To schedule an appointment, call 217-588-2726.