Brain Aneurysm Treatment

Endovascular Treatment

An alternative to open surgery, endovascular means “within the blood vessel.” Endovascular treatment allows doctors to thread special catheters (tiny tubes) and work through tiny blood vessels in the brain without having to cut through the scalp and remove a section of the skull.

Doctors perform endovascular treatment for aneurysms and other brain and spine vascular problems in BIDMC’s arteriography suite. The suite features the latest imaging technologies. These produce highly detailed, crystal clear images of blood vessels, blood flow and changes brought on by disease.

Endovascular Treatment for Arteriovenous Malformation (AVM)

At the Brain Aneurysm Institute, we excel at treating arteriovenous malformation (AVM). An AVM is a tangle of blood vessels that didn’t properly form. The AVM diverts oxygenated blood directly from an artery to a vein before the oxygen can nourish the surrounding brain or spine tissue.

Over time, these weak and abnormal blood vessels can dilate (expand), rupture and bleed. Based on the type, size and location of the AVM and your symptoms, treatment can include one or all of these steps:

• Surgery
• Endovascular embolization 
• CyberKnife stereotactic radiosurgery

Combination treatment using all three modalities is a special area of excellence at BIDMC. Our team works closely to coordinate the best approach and timing. We are highly experienced in endovascular technique to treat AVMs, and in sorting out the complexities of treatment.

Endovascular Treatment for Carotid-Cavernous Fistula (CCF)

A carotid-cavernous fistula (CCF) is an abnormal connection between an artery in the neck (carotid artery) and the veins behind the eye. If you have CCF, you may have eye redness, swelling and congestion that impacts your vision.

Our highly skilled, multidisciplinary team can use advanced endovascular techniques to treat your CCF. We can block the abnormal connection between the artery and the veins behind the eye. This works to reduce congestion and restore sight.

Endovascular embolization (coiling) is a technique for sealing a ruptured or unruptured aneurysm to prevent or stop bleeding. Embolization means blocking off the blood vessel or aneurysm from the inside, using coils or some other material.

You will be under general anesthesia, meaning you’re fully asleep for this procedure. Your doctor uses angiography imaging to guide endovascular embolization.

Your doctor threads a thin, hollow tube (catheter) carrying tiny metal coils through an artery in the groin to the aneurysm in the brain. Then, your doctor fills the aneurysm with the coils. The coils cause the blood to clot, which means that the aneurysm cannot circulate in your bloodstream.

You’ll need follow-up imaging after this procedure. Although effective, you may need the procedure more than once.

If the base of the aneurysm is wide or the aneurysm itself is large, doctors may need to use a small stent (mesh metal device) to hold the coils in place. The stent is permanent and stays inside the artery at the neck of the aneurysm.

In some cases, doctors inflate a removable balloon near the aneurysm to help position the coils in the sac. Once the coils are in the sac, doctors deflate and remove the balloon.

Stent design continues to evolve over time. Better, more secure coils are now available for large aneurysms and for easy retrieval if we need to remove them in the future. The stents we use at BIDMC are on technology’s leading edge.

Doctors may treat certain types of aneurysms with flow diverters, such as a pipeline embolization device (PED). Doctors use a catheter to position flow diverters, just like coils.

The pipeline device is a flexible, mesh tube that can block off aneurysms typically in the carotid artery. This major blood vessel brings blood to the front of the brain. Once in position, the pipeline expands against the artery wall and across the neck of the aneurysm. This reduces blood flow to the sac, which eventually clots and shrinks.

Dural Arteriovenous Fistula (DAVF) is an abnormal connection between the arteries within the dura mater (the thick membrane that covers the brain and spinal cord) and the veins that drain the brain. If a doctor doesn’t fix the DAVF, it can lead to brain hemorrhages or spinal cord malfunction.

If you have a DAVF, your care team may suggest open or minimally invasive brain surgery or CyberKnife stereotactic radiosurgery.

A carotid body tumor is a growth in the carotid artery, which are the blood vessels in the neck that carry blood to the brain. Multi-specialty teamwork is important for treating these abnormal growths. Your care team may include these and other specialists:

Generally, the first step of treatment is to use endovascular technique to embolize (block) the blood vessels that feed the tumor. Without blood, the tumor shrinks. Then, in an open procedure, brain surgeons can safely remove the abnormal growth. In some cases, care teams use radiation therapy to shrink carotid body tumors.