Coiling
- Endovascular treatment which involves navigating a catheter to the aneurysm site under fluoroscopic guidance
- A microcatheter is then advanced into the aneurysm sac and metal coils are deposited
- Coils arrest blood flow and induces thrombus formation which occludes aneurysm
- The coils are kept within the aneurysm sac an out of the vessel lumen by either a stent (stent-assisted coiling) or a balloon (balloon-assisted coiling)
Clipping
- Requires a craniotomy and exploration of the subarachnoid spaces around the cerebral arteries
- Once the aneurysm is exposed, a single or multiple titanium clips are placed across the neck of the aneurysm
- Results in mechanical occlusion the sac at its neck while preserving blood flow through the vessel lumen
Stenting
- Endovascular insertion of stents may be utilised in certain situations
- Flow-diverting stents are a new generation of stents designed to occlude the aneurysm by isolating the sac from the circulation - useful in fusiform and wide neck aneurysms
- Simple stenting is often used to treat dissecting aneurysms of the cerebral vessels
Trapping
- Used for giant aneurysms (>25mm diameter) where other methods have failed
- The aneurysm is trapped by two clips applied to the vessel either side
- A bypass graft is then used to provide blood flow to the distal vessels