Brain Aneurysma Embolization

Brain aneurysm endovascular treatment

The aim of aneurysm treatment is to eliminate the potential risk of cerebral hemorrhage that may develop as a result of the rupture of the aneurysm. The basic principle of aneurysm treatment is to prevent blood flow into the aneurysm by closing the aneurysm sac. Closed methods (endovascular treatment) are the first choice in the treatment of aneurysms.

Scientific studies have proven that closed aneurysm treatment is a very safe and effective method. Closed aneurysm surgery may take between 1.5 and 4 hours, depending on the technique to be applied and many other factors

All closed aneurysm treatment methods are administered intravenously without opening the patient’s skull.

Endovascular aneurysm treatment is performed with different methods in terms of the material used and the technique applied. The most appropriate closed treatment method for the patient is selected and applied by considering factors such as the size of the aneurysm, the relationship of the aneurysm with the vessels, whether the aneurysm bleeds or not, and the patient’s age.

Closed aneurysm treatment with coil

All closed aneurysm treatments are performed by putting the patient to sleep with general anesthesia. All stages of closed aneurysm treatment are administered through a special catheter with a diameter of 2 mm (thinner than a pencil) inserted into the leg artery. A very

thin (0.5mm in diameter) and soft structure special plastic tube called microcatheter is sent into the vein from this small entry point.

This microcatheter, which we use to close the aneurysm, is monitored by the angiography device and guided into the vessel where the aneurysm is located. The tip of the microcatheter, which is a hollow, very thin and soft plastic tube, is inserted into the aneurysm sac. Then, the aneurysm sac is filled with very soft wires called “coils” made of platinum sent through this microcatheter. Coils form a ball in the aneurysm sac and prevent blood from entering the aneurysm. When the aneurysm sac is completely filled with coils and blood flow into the aneurysm is completely stopped, the procedure is completed by withdrawing the microcatheter from the aneurysm.

The process of closing the aneurysm by filling it with special wires called coils is called “coiling”. Coil closure of the aneurysm is a very safe and effective treatment method. The patient with an unblended brain aneurysm can return to his normal daily life 1-2 days after being treated with the coiling method.

Closed aneurysm treatment with stent-assisted coiling

The point where the aneurysm sac connects with the vessel is called the neck of the aneurysm. In the treatment of aneurysms with a wide neck, it may be necessary to use assistive devices so that the coils to be placed in the aneurysm do not protrude into the main vein. During coiling of wide neck aneurysms, it may be necessary to use special balloons or stents (metal cage).

We call the closure of wide-neck aneurysms with coils using a stent as “stent-assisted coiling”. In the first stage of this procedure, a metal cage (stent) is placed into the vein to cover the neck of the aneurysm, and in the next stage, the coils placed in the aneurysm sac are prevented from sagging into the vein. In other words, the task of the stent is to prevent the wires, called coils, which we fill into the aneurysm, from sagging into the vein. Stent-assisted coiling is the preferred method in the closed method of treating wide neck aneurysms.

Like a dam set on a fast-flowing river, stents prevent blood flow from reaching the aneurysm under pressure and prevent the closed aneurysm from reopening. Today, we can successfully treat even the most complex aneurysms with a very wide neck and many vessels, by applying the stent-assisted coiling technique. The stents we use in the treatment of aneurysms are devices that are soft and fully compatible with the body, produced with advanced technology in a way that will not damage the vessel wall.

Closed aneurysm treatment with balloon assisted coiling

Another method used in the endovascular treatment of wide neck aneurysms is “Balloon-assisted coiling”. In this method, the hanging of the coils placed in the aneurysm into the vein is prevented with the help of the balloon catheter, which is inflated in the vein for a very short time. The inflated balloon in the vein prevents the coils placed in the aneurysm sac from sagging into the vein. After the coil is properly placed, the balloon is deflated. This process is repeated until the aneurysm is completely filled.

Closed aneurysm treatment with flow-guiding stent

Flow routing technique is another closed aneurysm treatment method. In this technique, unlike other methods, the aneurysm is not filled with coils. In this method, special stents with the ability to direct the blood flow are placed into the vessel where the aneurysm is located. We call these stents “converter stents”. Streamer stents are metal cages with a very dense mesh structure. Compared to other stents, there are fewer pores and more metal wires in the wall of the current-converting stents. Thanks to these structural features, flow-diverting stents have the ability to re-direct the blood flow in the vessel.

In this method, the blood flow into the aneurysm sac before the stent is directed into the vessel by the stent. In this way, the blood flow into the aneurysm is reduced and completely stopped in a short time. The aneurysm, whose blood flow is seriously reduced, shrinks by coagulation and disappears in a short time. Even aneurysms, which were considered to be incurable or very risky until the last 4-5 years, can be treated with high success rates thanks to flow-converting stents today.

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