Neurointervention · IR Playbook

Endovascular Coiling of Intracranial Aneurysms (aneurysm coiling)

Endovascular coiling is the transarterial deployment of detachable platinum coils into an intracranial aneurysm sac to exclude it from the circulation, most often to prevent rebleeding after aneurysmal subarachnoid haemorrhage. It works by mechanical flow disruption within the sac followed by thrombus organisation and endothelialisation across the neck, so the entire complication profile follows from three facts: the coil mass sits inside a thin ruptured wall (intraprocedural rupture), it lies against flowing blood at the neck (thromboembolism and prolapse), and the seal is thrombotic rather than surgical (recanalisation and late rebleeding). Guideline-supported: in patients in good clinical condition with a ruptured aneurysm suitable for both treatments, coiling reduces death or dependency at 1 year compared with clipping, with an odds ratio of 0.69 and an absolute risk reduction of about 7 percent, and the benefit persists at 10 years. The durability trade-off is real, with residual or recurrent filling substantially more common after coiling than after clipping, which is why imaging follow-up is mandatory.

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