As a brain aneurysm specialist, I’ve seen how endovascular treatment has transformed patient care. By navigating tiny catheters through the blood vessels, we can repair aneurysms without opening the skull. This minimally invasive approach significantly reduces complications, shortens hospital stays, and allows patients to return to their lives sooner, often with less pain and faster recovery.
What is a Brain Aneurysm?
A brain aneurysm happens when a blood vessel in the brain becomes weakened and starts to bulge. Without treatment, brain aneurysms can burst or rupture, causing a subarachnoid haemorrhage which can cause extensive brain damage and be fatal. Most brain aneurysms have no symptoms unless they do rupture, and the majority do not rupture and are at low risk of rupturing, so are not treated beyond monitoring. Brain aneurysm symptoms include photosensitivity, stiff neck, nausea, and a headache worse than anything experienced before, sometimes called a "thunderclap headache." However, brain aneurysm detection often occurs when a scan is done to check for something else. Certain headache-related vascular conditions may benefit from minimally invasive neurointerventional treatment approaches.
Other conditions that are sometimes treated with endovascular techniques are arteriovenous malformations (AVMs), dural arteriovenous fistulas (DAVFs), carotid artery stenosis, and intracranial hemorrhage.
This article is part of our guide to brain aneurysm imaging, screening, and diagnosis. For a complete overview, visit our Brain Aneurysm MRI and CT Scans guide.
Common Questions About Modern Endovascular Brain Aneurysm Treatment
What is endovascular treatment for a brain aneurysm?
Endovascular treatment is a minimally invasive approach that treats a brain aneurysm from inside the blood vessel using a thin catheter. Depending on the aneurysm's size, shape and location, treatment may include coiling, stent-assisted coiling, flow diversion or other specialised endovascular techniques.
How has endovascular treatment changed brain aneurysm care?
Advances in endovascular technology have expanded the number of brain aneurysms that can be treated without open brain surgery. Modern techniques offer more personalised treatment options, allowing specialists to select the most appropriate approach based on each patient's anatomy and clinical condition.
Is endovascular treatment suitable for every brain aneurysm?
No. The most appropriate treatment depends on several factors, including the aneurysm's location, size, shape, whether it has ruptured and your overall health. Some aneurysms are best managed with monitoring, while others may benefit from endovascular treatment or microsurgical clipping.
What are the advantages of minimally invasive brain aneurysm treatment?
For suitable patients, minimally invasive endovascular treatment may offer smaller access sites, reduced disruption to surrounding tissues, shorter hospital stays and faster recovery compared with open surgery. Treatment recommendations are always individualised based on clinical assessment.
Will I need follow-up after endovascular treatment?
Yes. Regular follow-up is an important part of long-term care. Your specialist may recommend CTA, MRA or cerebral angiography to assess the treated aneurysm, monitor healing and determine whether ongoing surveillance is required.
What is Endovascular Treatment?
Endovascular treatment involves using a catheter to access the blood vessel and patch the aneurysm in a minimally invasive manner. The surgeon accesses the vascular system through a small incision in the groin or wrist and uses advanced imaging technology to guide the catheter into position.
Endovascular Treatment Options for Brain Aneurysms
The goal of treatment is to cut off blood flow to the aneurysm, which will then close off on its own. There are three common treatments:
- Coiling. A tiny platinum coil is placed inside the aneurysm to block blood flow and stabilize the aneurysm, preventing rupture. Coiling is the most common procedure.
- Flow diverters. A tubular stent is used to redirect blood flow past the aneurysm.
- Stent-assisted coiling. This combines the two and is used for wide-neck aneurysms that can't be blocked by coils alone.
Compared to open surgery, endovascular treatment offers less trauma and faster recovery. Some areas also can't be safely accessed by open surgery.
Endovascular Management of Other Neurovascular Conditions
Endovascular treatment can also help with other neurovascular conditions. These include:
- AVMs and DAVFs: In these conditions, abnormal connections between blood vessels bypass tissue. AVMs are present from birth and are typically asymptomatic, although symptoms can happen after pregnancy, and they can rarely hemorrhage, with severe effects. DAVFs, on the other hand, are typically caused by trauma, such as a severe sinus infection. Some of these are also asymptomatic, but most have symptoms that might include headaches, seizures, coordination issues, and vision problems. Asymptomatic deformities are not typically treated, but endovascular surgery using embolic material or coils is a common treatment when symptoms occur.
- Ischemic stroke: In this case, endovascular treatment takes the form of mechanical thrombectomy to remove a clot and restore blood flow to the brain. This can't restore existing damage but can reduce further risk.
- Carotid artery stenosis: Carotid artery stenting is used to widen narrowed vessels and restore blood flow.
Any of these conditions can result in death and this treatment saves many lives, whether performed during an emergency or as a preventive measure.
Advantages of Endovascular Approaches
Endovascular approaches have many advantages over open surgery. Avoiding open brain surgery reduces risks substantially, and additionally, endovascular approaches are associated with shorter hospital stays, quicker recovery and, in many cases, lower complication rates. In addition, elderly and high risk patients who might not be good candidates for open surgery can often tolerate endovascular procedures.
What to Expect During and After the Procedure
Endovascular treatment takes place in a specialized angiography suite. You will undergo basic pre-admission testing including blood tests, an EKG, and a chest X-ray. You may be put on medication to prevent blood clotting. If so, this typically starts one week before treatment and runs through three months after.
You will be placed under general anesthesia or deep sedation. If the incision is being made in the groin, you will be shaved. A thin tube is placed in the artery and the doctor will insert a guide wire and a catheter that will be moved to the site of the aneurysm. A smaller microcatheter is then inserted to put the coil or flow diversion device inside. Before the procedure, you will get scans so a coil of the right size and shape is used, especially as many brain aneurysms have an irregular shape. In some cases, more than one coil is needed.
Afterwards, you will be monitored in a recovery area. Most people with unruptured aneurysms are discharged within 24 hours. If your aneurysm ruptured, you might need to be monitored for longer. However, there is minimal downtime once you go home. You will be scheduled for follow-up imaging to make sure the coil or device is stable.
When to Consider a Vascular Specialist Assessment
Advances in endovascular techniques mean that many patients now have more treatment options than ever before. A specialist assessment helps determine whether minimally invasive treatment is appropriate for your specific brain aneurysm.
Consider seeking a specialist assessment if you:
- Have been diagnosed with a brain aneurysm and would like to understand all available treatment options
- Have been advised that your aneurysm may require coiling, stent-assisted coiling or flow diversion
- Have abnormal findings on CT, MRI, CTA, MRA or cerebral angiography
- Have an unruptured brain aneurysm and are deciding between monitoring and intervention
- Have previously undergone brain aneurysm treatment and require long-term follow-up
- Would like a second opinion regarding minimally invasive treatment versus microsurgical clipping
A specialist consultation includes reviewing your symptoms, medical history and brain imaging before discussing the benefits, considerations and expected outcomes of the available treatment options.
Seek emergency medical attention immediately if you develop a sudden severe headache, weakness, difficulty speaking, seizures, loss of consciousness or sudden vision changes. These symptoms may indicate a ruptured brain aneurysm or another neurological emergency requiring immediate treatment.
Discover the Right Endovascular Treatment For You at Our Specialized Brain Aneurysm Clinic in Singapore
We consider various factors when deciding whether you should get endovascular treatment. The size and location of the aneurysm matters a lot. Small aneurysms that have a low risk of rupture may be monitored, rather than treated right away. We also consider your overall health.
As a multidisciplinary brain aneurysm specialist in Singapore, Dr. Manish Taneja is helps make the right decision on when and whether endovascular treatment should be performed. In rare cases, open surgery may still be necessary. However, endovascular technology has transformed how we treat brain aneurysms and neurovascular diseases, and continues to do so. As many of these issues are asymptomatic, screening and early detection is important. If you'd like to explore which brain aneurysm treatment and minimally invasive care is right for you, visit our Brain Aneurysm Treatment Decision Guide.
If you or a loved one has been diagnosed with a brain aneurysm or neurovascular condition, consult neurointervention and vascular specialist Dr. Manish Taneja, to explore minimally invasive treatment options. Contact the Supreme Vascular and Interventional Clinic to arrange an appointment today.
Brain Aneurysm Resources
Discover brain aneurysm resources that go beyond the basics designed for patients. Understand the meaning of a brain aneurysm condition, the causes, symptoms, signs, and more. Connect with your brain health.
Put Brain Aneurysm on Your Health Radar
Did you experience the worst headache of your life? Thoughts could be racing through your mind. A brain aneurysm is a weak spot in a blood vessel in the brain that can change over time. The key concern is when an aneurysm ruptures, which can disrupt blood flow, affect brain tissue, and lead to serious brain damage. Controllable conditions like high blood pressure can increase this risk and treatment options can depend on the condition. Surgical clipping is one option that prevents blood from entering the weakened area. In many cases, minimally invasive treatments can also be used to restore normal blood flow and reduce risk. We have created structured guides to help you explore each stage in more detail:
A simple (computed tomography) CT scan could be just what the doctor ordered and the first step in early detection and prevention of a brain aneurysm. Come in for an easy consultation with our brain aneurysm specialist in Singapore to be on your health radar.
Other Health Conditions
The Supreme Vascular and Interventional Clinic is your "go-to" facility for various neurointerventional / stroke conditions and treatments. To arrange an appointment with Dr. Manish Taneja, our brain aneurysm specialist, contact us. You can also call us at (+65) 6904 8084 for a consultation.