Angiographic image after coil embolization (performed because the patient had SAH) reveals a coil within the aneurysm.

Coil Embolization Complications

* Complicaton rate 8.6% to 18.6% (median 10.6%), lower than surgical clipping
* Common complications: thrombo-embolic events, perforation of aneurysm, parent artery obstruction, collapsed coil, coil malposition, and coil migration

Coil Embolization versus Aneurysm Clipping

* Less risks of death
* Higher rate of rebleeding (2.4% versus 1%) - why*
* Advantages vary depending on location of aneurysm, but coil embolization is beneficial for all sites

*Percentage of complete aneurysm occlusion after coil embolization is lower than with surgical clipping
* Recurrence = refilling of thee neck, sac, dome of a successfully treated aneurysm

What to Choose?

* Not all aneurysms required coil embolization. This depends on size, anatomy and location of aneurysms.
* People at increased risk for craniotomy (>65 years, poor clinical status, comorbid conditions)
* Suitability depends on size, anatomy, location of aneurysms (in ophthalmic artery or basilar tip artery)
* Better perform craniotomy if
* >10 mm size
* > 4mm neck

Case contributed by RiT