Aneurysm treatment options

Cerebral aneurysms can be treated with coiling (endovascular treatment) or surgical clipping. The shape of the aneurysm and the relationship to the parent vessel determines whether the aneurysm should be treated with coiling or clipping. Almost 90% of aneurysms are treatable with endovascular techniques. We evaluate every individual case and advise on the best and safest treatment modality.

It is now proven that coiling is associated with a lower treatment risk compared to surgical techniques (according to the ISAT trial data).

A stent or balloon may be required in addition to the coiling if the aneurysm has a wide neck. When stents (and flow diverter stents) are used, the patient needs to use anti platelet medication – usually asprin and clopidogrel – to prevent thrombosis on the stent.

Aneurysm treatment options

Endovascular treatment procedure

The procedure is done under general anaesthetic and access is obtained from a femoral artery in the groin. A diagnostic cerebral angiogram is performed and the aneurysm is analysed. A very thin micro-catheter is then placed very carefully into the aneurysm and through this micro-catheter a number of platinum coils are placed. This will prevent blood flow into the aneurysm and therefore the aneurysm can not bleed again.

Post-procedure intensive care is needed to manage possible complications of the subarachnoid haemorrhage,  such as arterial spasm and hydrocephalus.

The overall risk of this procedure is low especially when compared to the risk of not treating a ruptured aneurysm.

Endovascular treatment procedure


  • Bleeding from the arterial access in the groin after the procedure

  • Stroke caused by blood clots forming on the catheters or coils

  • Stroke due to damage to arteries caused by catheters or guide wires

  • Rupture of the aneurysm during treatment – less than 1% chance

Follow up

After coiling of an aneurysm there is a possibility of delayed recurrence due to coil compaction or aneurysm growth. According to the literature the recurrence rate is 20% of which half of the cases may require additional treatment. We found the recurrence rate in our practice to be lower.

In view of the risk of recurrence the coiled aneurysm must be followed up. We do routine follow up angiography at 6 months and at 2 years we do angiography or MR angiography. MR angiography is recommended every two years thereafter.