Brain Aneurysm Coiling, Carotid Stenting and Cerebral DSA

Digital subtraction angiography gives the most detailed pictures of the blood vessels of the brain and neck. A thin catheter is passed to the arteries and contrast dye is injected while X-ray images are taken. It is used to confirm and measure an aneurysm or narrowing, and to plan treatment.

In coiling, a microcatheter is guided into the aneurysm and soft platinum coils are placed inside it, so blood no longer flows into the weak bulge. It is used for selected ruptured aneurysms, to prevent re-bleeding, and for unruptured aneurysms that need treatment.

A flow diverter is a fine mesh stent placed in the parent artery across the neck of the aneurysm. It redirects blood flow so the aneurysm gradually clots and seals over time. It needs antiplatelet medicines before and after treatment.

When a neck (carotid) artery is badly narrowed by plaque, especially after a TIA or minor stroke, a stent can hold it open and lower the risk of a future stroke. People with diabetes, high blood pressure, high cholesterol or a smoking history are at higher risk of this narrowing.

Not all carotid narrowing needs a stent. Many people are treated with medicines and risk-factor control.