- Patients who have recently undergone aneurysmal coiling commonly present to the ED with complaints of new or worsened focal neurologic deficits that may be suggestive of stroke.
- Aneurysms can be stabilized by clipping or coiling them. Coiling is performed in a minimally invasive manner, wherein platinum (a material that can be visualized radiographically and is flexible) coils are deployed into the bulb of the aneurysm, via femoral artery cannulation.
- The relative risk of mortality or morbidity at one year post-coiling was found to be 22.6% less than that associated with clipping. The latter is an older, more invasive technique requiring craniotomy and direct manipulation of the brain.
- Hemorrhage is a less likely complication related to aneurysm coiling, thus your indication for a non-contrast Head CT in these patients would most appropriately be "rule out infarct" rather than "rule out bleed."
- Brain infarct is the more common complication of this treatment, and results from the accidental embolization of plaque during the coiling procedure.
- Here are a couple of great links with illustrated overviews of the process of coiling, including a real time You Tube clip:
http://www.brainaneurysm.com/aneurysm-treatment.html
http://www.youtube.com/watch?v=Mvy8g_oDbbk