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Ruptured Cerebral Aneurysm — Endovascular Treatment

Endovascular therapy (coiling) is one of the primary, contemporary, and minimally invasive options for definitive treatment of a ruptured cerebral aneurysm. Its aim is to rapidly prevent rebleeding—often with a faster recovery and a reduced physiological burden compared with open surgery in appropriately selected patients.

Minimally invasive approach First-line therapy for many patients Typically within the first 72 hours ISAT & BRAT — strong clinical outcomes

What is endovascular treatment?

This is a minimally invasive technique in which a neurointerventional specialist introduces a microcatheter through the femoral or radial artery and delivers coils (fine, spring-like metallic devices) into the aneurysm. The aneurysm then thromboses and is excluded from the circulation, helping to prevent further bleeding.

Goal: prompt aneurysm securing and prevention of rebleeding—the most immediate and critical threat after rupture.

Who is it typically recommended for?

Posterior circulation aneurysms (basilar, PICA, vertebral)
Patients at higher operative risk
Aneurysms with anatomy suitable for coiling
Advanced age or significant medical comorbidities
Absence of a large intracerebral hematoma requiring urgent decompression

How is the procedure performed?

General anesthesia in an angiography suite (often a hybrid setting)
Catheter access via the groin or wrist
Fluoroscopic navigation to the aneurysm
Coil deployment until satisfactory occlusion is achieved
Final angiographic assessment of flow and stability

In selected cases, adjunctive techniques such as balloon remodeling or stent-assisted coiling may be used.

Advantages

No craniotomy
Often shorter hospitalization and recovery
Reduced postoperative pain in many patients
Particularly useful for sensitive or surgically challenging anatomy

Risks & potential complications

Thromboembolism and ischemic stroke
Intra-procedural rerupture/bleeding (uncommon)
Need for follow-up imaging and, in some cases, retreatment

Trials such as ISAT and BRAT demonstrate excellent functional outcomes when treatment selection is individualized and performed in experienced centers.

Recovery & follow-up

Most patients are managed in a neurosurgical intensive care unit to monitor for vasospasm, hydrocephalus, and neurological changes. Follow-up imaging may be recommended over the subsequent months to confirm durable aneurysm occlusion.

How does it compare with clipping?

The two approaches are not competitors—they are complementary. For some aneurysms, endovascular treatment is the most appropriate option; for others, microsurgical clipping may be safer and more durable. The optimal strategy depends on aneurysm anatomy and the patient’s overall clinical scenario.

Learn more about the surgical alternative: Microsurgical Aneurysm Clipping

Frequently asked questions

Is the procedure painful?

No — it is performed under general anesthesia.

Will I need a second procedure?

A minority of patients—particularly those with large or wide-necked aneurysms—may require follow-up and, in some cases, additional treatment based on surveillance imaging.

How soon can I return to everyday activities?

Often within weeks, depending on the severity of the hemorrhage and your overall clinical course.

Have you been advised to undergo endovascular treatment for a ruptured aneurysm?

The Neuroknife team provides comprehensive evaluation, an individualized treatment strategy, and coordinated follow-up in collaboration with leading neurosurgical centers.

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