Cerebral aneurysms can result in subarachnoid hemorrhages – bleeding in the space filled with cerebrospinal fluid that surrounds the brain. The consequences of such hemorrhages can be devastating, with 70 percent of patients either dying or suffering severe, disabling stroke.

The recent International Subarachnoid Aneurysm Trial (ISAT) compared the outcomes of patients treated for a ruptured intracranial aneurysm with the standard surgical technique – open craniotomy and surgical clipping – and those treated with a detachable endovascular coil. Overall, patients treated with an endovascular coil experienced better outcomes than those treated with conventional surgery. The ISAT patients treated with an endovascular coil were found to have a 7.4 percent lower risk of death or dependence than those who underwent craniotomy and clipping.

The trial included only patients who would have been suitable candidates for either procedure. There are many patients who, because of the anatomy and location of the aneurysm, would be considered better candidates for endovascular treatment; there are also patients who would be better candidates for the surgical treatment. This often has to do with the anatomy of the aneurysm and the nature of its connection to its parent artery.

A treatment invented at UCLA

The first endovascular coil, known as the Guglielmi Detachable Coil (GDC) was invented at UCLA in the
late 1980s by Guido Guglielmi, M.D., Ph.D. The first cases were performed using the GDC at UCLA in 1991; since that time, UCLA interventional neuroradiologists have performed the procedure in over 1,200 cases.

Treating aneurysms with the endovascular coil

An aneurysm is like a balloon attached to the artery. The goal of endovascular coiling is embolization, sealing the opening to the aneurysm to reduce blood flow and arrest or prevent a hemorrhage. The interventional neuroradiologist inserts a coil that is the largest diameter that the aneurysm will accommodate. As the coil is inserted, it takes the shape of the aneurysm and forms a framework that is filled in with successively smaller coils.

With modern neuroimaging, unruptured aneurysms are often discovered
incidentally and can be treated to prevent a hemorrhage. The complication
rate associated with the embolization procedure is very low – on the order of
2 percent to 3 percent – compared to the significant lifetime risk of leaving
large or growing aneurysms untreated.

The technique is the same for patients with ruptured and unruptured
aneurysms, although cases of ruptured aneurysms are emergencies and the
patients require more intensive care as they have already suffered some
damage. Patients with unruptured aneurysms are typically admitted for
embolization treatment on the day of the procedure, which is done under
general anesthesia. If there are no complications, the patient is discharged
the following day and can return to work as early as 48 hours after the procedure.

UCLA neurovascular medicine

UCLA physicians treat aneurysms with the most appropriate technique –
either endovascular coil or open craniotomy and clipping – given the
location and anatomy of the aneurysm as well as other factors of the
individual case. UCLA offers minimally invasive imaging to identify
aneurysms and, where small aneurysms are found that don’t require
immediate treatment, can monitor the patient for aneurysm growth.

UCLA also offers treatment for cerebral arteriovenous malformations (AVMs) and fistulas and performs brachiocephalic, carotid and intracranial angioplasty. UCLA has an acute stroke service and the Merci device for stroke intervention, which was also invented at UCLA.

Division of Interventional Neuroradiology physicians

Gary Duckwiler, M.D.
Reza Jahan, M.D.
Satoshi Tateshima, M.D.
Fernando Vinuela, M.D.