What is Endovascular Therapy for Cerebral Aneurysm
A cerebral aneurysm is a weak spot in a blood vessel (artery) in the brain. The weak spot fills with blood and it bulges. This can put pressure on nerves or on other blood vessels.
If the aneurysm bursts (ruptures), it can cause bleeding in the brain (cerebral hemorrhage). A cerebral hemorrhage is a medical emergency that can lead to serious health problems or death.
Endovascular therapy is a procedure that fills the aneurysm with small, platinum coils. The coils destroy the aneurysm by preventing blood from flowing into it.
This treatment is also called endovascular embolization or coiling. This may be done for an aneurysm that is or is not ruptured. In some cases, the procedure may need to be repeated.
Tell a health care provider about:
- Any allergies you have.
- All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
- Any problems you or family members have had with anesthetic medicines.
- Any blood disorders you have.
- Any medical conditions you have.
- Any surgeries you have had.
- Whether you are pregnant or may be pregnant.
- Whether you smoke or use tobacco products.
What are the risks?
Generally, this is a safe procedure. However, problems may occur, including:
- Infection.
- Bleeding.
- Stroke.
- Brain injury, which may result in vision or speech difficulty, memory loss, or behavior and thinking problems.
- Damage to other structures or organs.
- Blood clots.
- Allergic reaction to medicines or dyes.
What happens before the procedure?
Staying hydrated
Follow instructions from your health care provider about hydration, which may include:
- Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.
Eating and drinking restrictions
Follow instructions from your health care provider about eating or drinking, which may include:
- 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
- 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
- 6 hours before the procedure – stop drinking milk or drinks that contain milk.
- 2 hours before the procedure – stop drinking clear liquids.
Medicines
- Ask
your health care provider about:
- Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
- Taking over-the-counter medicines, vitamins, herbs, and supplements.
- Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do not take these medicines unless your health care provider tells you to take them.
- You may be given antibiotic medicine to help prevent infection.
General instructions
- You may be asked to shower with a germ-killing soap.
- You may have a blood or urine sample taken.
- Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
- You may have a neurological exam or testing to check brain and nerve function.
- You may have imaging tests done, such as CT scan or MRI.
What happens during the procedure?
- To
lower your risk of infection:
- Your health care team will wash or sanitize their hands.
- Hair may be removed from the surgical area
- The skin in your groin area will be washed with soap.
- An IV will be inserted into one of your veins.
- You
will be given one or more of the following:
- A medicine to help you relax (sedative).
- A medicine to numb the area (local anesthetic).
- A medicine to make you fall asleep (general anesthetic).
- A small incision will be made near your groin, above one of the main arteries that can be used to reach the brain (femoral artery). In rare cases, an incision will be made in your arm instead.
- A small, thin tube (catheter) will be inserted into the femoral artery.
- Dye will be injected into the catheter, and then X-rays will be taken (angiogram). The dye helps to show the location of the catheter and the aneurysm on the X-rays.
- The catheter will be moved up to the aneurysm, using X-ray images as a guide.
- A small wire (guide wire) will be used to pass small platinum coils through the catheter to the aneurysm.
- After the coils are placed inside the aneurysm, a small electric current will be sent through the guide wire. This will cause the coils to separate (detach) from the wire. The coils will stay inside the aneurysm, blocking blood flow to the aneurysm.
- In some cases, a small balloon (balloon catheter) or a flexible cage (stent) may be inserted into the artery. This will help to keep the coils in place if the opening to the aneurysm is large.
- The guide wire and catheter will be removed.
- Your incision will be closed with a plug, clip, or stitches (sutures), then covered with a bandage (dressing).
The procedure may vary among health care providers and hospitals.
What happens after the procedure?
- You will be moved to an intensive care unit (ICU). Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
- Your activity will be restricted.
- You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
- Do notdrive until your health care provider approves.
Summary
- A cerebral aneurysm is a weak spot in a blood vessel in the brain. When the aneurysm fills with blood, it can put pressure on nerves or on other blood vessels.
- If a cerebral aneurysm is not treated, it can burst and cause bleeding in the brain (cerebral hemorrhage).
- Endovascular therapy is a procedure that fills an aneurysm with small, platinum coils. The coils prevent blood from filling the aneurysm.
- In some cases, this treatment may need to be repeated.
- After this procedure, you will be monitored in the ICU. You will have activity restrictions while your body heals.
Endovascular Therapy for Cerebral Aneurysm, Care After
This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.
What can I expect after the procedure?
After the procedure, it is common to have:
- Pain, tenderness, and swelling around your incision.
- Headaches.
Follow these instructions at home:
Medicines
- Take over-the-counter and prescription medicines only as told by your health care provider.
- If you were prescribed medicines to prevent blood clots (antiplatelet medicines), talk with your health care provider about the risks. These medicines can increase bleeding, so you may need to avoid certain activities.
Incision care
- Follow
instructions from your health care provider about how to take care of your
incision. Make sure you:
- Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
- Change your dressing as told by your health care provider.
- Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.
Check your incision area every day for signs of infection. Check for:
- Redness, swelling, or pain.
- Fluid or blood.
- Warmth.
- Pus or a bad smell.
Activity
- Ask your health care provider what activities are safe for you during recovery. Most people can return to normal activities 2–6 weeks after the procedure.
- Do notdrive until your health care provider approves.
- Do notdrive or use heavy machinery while taking prescription pain medicine.
- Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.
- Exercise regularly, as directed by your health care provider.
- Attend
rehabilitation therapy as told by your health care provider. This may
include:
- Physical and occupational therapy.
- Speech-language therapy.
- Brain exercises.
- Balance exercises.
- Individual or group therapy.
- Education about your condition and treatment.
Eating and drinking
- Drink enough fluid to keep your urine pale yellow.
Eat a healthy diet. This includes plenty of fruits and vegetables, whole grains, low-fat dairy products, and lean protein.
General instructions
- Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
- Do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths for bathing.
- Manage your stress. If you need help with this, talk with your health care provider.
- Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
- Keep all follow-up visits as told by your health care provider. This is important.
Contact a health care provider if:
- You have redness, swelling, or pain around your incision.
- You have fluid or blood coming from your incision.
- Your incision feels warm to the touch.
- You have pus or a bad smell coming from your incision.
- You have a fever.
Get help right away if:
- You
have:
- Stiffness in your neck.
- Pain, numbness, weakness, or swelling in your legs.
- Severe chest pain.
- Difficulty breathing.
- Confusion.
- You
have any symptoms of stroke. “ BE FAST”is an easy
way to remember the main warning signs of stroke:
- B – Balance.Signs are dizziness, sudden trouble walking, or loss of balance.
- E – Eyes.Signs are trouble seeing or a sudden change in vision.
- F – Face.Signs are sudden weakness or numbness of the face, or the face or eyelid drooping on one side.
- A – Arms.Signs are weakness or numbness in an arm. This happens suddenly and usually on one side of the body.
- S – Speech.Signs are sudden trouble speaking, slurred speech, or trouble understanding what people say.
- T – Time. Time to call emergency services. Write down what time symptoms started.
- You
have other signs of stroke, such as:
- A sudden, severe headache that does not get better with medicine.
- Sudden nausea or vomiting.
- A seizure.
These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.
Summary
- After this procedure, it is common to have some pain and swelling around your incision.
- Follow instructions from your health care provider about how to take care of your incision. Check for signs of infection every day.
- Most people can return to normal activities 2–6 weeks after the procedure. Ask your health care provider what activities are safe for you during recovery.
- Do notdrive until your health care provider approves. Do notdrive while taking prescription pain medicine.
- Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
