Unassisted Aneurysm Coil Embolization

  • Kyle M. Fargen
  • Jasmeet Singh
  • John A. Wilson
  • Stacey Q. Wolfe


Unassisted coiling is a safe and effective treatment strategy for both ruptured and unruptured aneurysms with favorable anatomy. Those aneurysms best suited for unassisted coiling have straightforward microcatheter access, are small or medium sized, have a narrow neck, and a high dome/neck ratio. Aneurysms with wide necks or incorporate bifurcating branches are less favorable due to the possibility of coil prolapse and thromboembolic complication. A wide selection of different microcatheter shapes and coil conformations is available to tailor the treatment to unique aneurysm anatomy. Operators should prepare for the potential need for additional microcatheters by using an appropriately sized guide catheter (usually 6 French), should dual microcatheter technique or balloon or stent assistance be required. Overall, outcomes with unassisted coiling of appropriate aneurysms are excellent, with retreatment rates approximating 15%. In this chapter, we discuss indications and contraindications for primary coiling, basic principles of catheterization, coil selection, coil deployment, and outcomes associated with unassisted aneurysm coiling.


Aneurysm coil embolization Coil embolization Endovascular Occlusion Unassisted aneurysm coil embolization 


  1. 1.
    Guglielmi G, Vinuela F, Sepetka I, Macellari V. Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: electrochemical basis, technique, and experimental results. J Neurosurg. 1991;75(1):1–7.CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Guglielmi G, Vinuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: preliminary clinical experience. J Neurosurg. 1991;75(1):8–14.CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Gruber A, Killer M, Bavinzski G, Richling B. Clinical and angiographic results of endosaccular coiling treatment of giant and very large intracranial aneurysms: a 7-year, single-center experience. Neurosurgery. 1999;45(4):793–803. discussion 803-794CrossRefGoogle Scholar
  4. 4.
    van Rooij WJ, Sluzewski M. Coiling of very large and giant basilar tip aneurysms: midterm clinical and angiographic results. AJNR Am J Neuroradiol. 2007;28(7):1405–8.CrossRefGoogle Scholar
  5. 5.
    Sluzewski M, Menovsky T, van Rooij WJ, Wijnalda D. Coiling of very large or giant cerebral aneurysms: long-term clinical and serial angiographic results. AJNR Am J Neuroradiol. 2003;24(2):257–62.PubMedGoogle Scholar
  6. 6.
    Brinjikji W, Piano M, Fang S, et al. Treatment of ruptured complex and large/giant ruptured cerebral aneurysms by acute coiling followed by staged flow diversion. J Neurosurg. 2016;125(1):120–7.CrossRefGoogle Scholar
  7. 7.
    White JB, Ken CG, Cloft HJ, Kallmes DF. Coils in a nutshell: a review of coil physical properties. AJNR Am J Neuroradiol. 2008;29(7):1242–6.CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Marks MP, Tsai C, Chee H. In vitro evaluation of coils for endovascular therapy. AJNR Am J Neuroradiol. 1996;17(1):29–34.PubMedGoogle Scholar
  9. 9.
    Meyers PM, Lavine SD, Fitzsimmons BF, et al. Chemical meningitis after cerebral aneurysm treatment using two second-generation aneurysm coils: report of two cases. Neurosurgery. 2004;55(5):1222.CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Eddleman CS, Welch BG, Vance AZ, et al. Endovascular coils: properties, technical complications and salvage techniques. J Neurointerv Surg. 2013;5(2):104–9.CrossRefGoogle Scholar
  11. 11.
    Ishida W, Sato M, Amano T, Matsumaru Y. The significant impact of framing coils on long-term outcomes in endovascular coiling for intracranial aneurysms: how to select an appropriate framing coil. J Neurosurg. 2016;125(3):705–12.CrossRefGoogle Scholar
  12. 12.
    Sluzewski M, van Rooij WJ, Slob MJ, Bescos JO, Slump CH, Wijnalda D. Relation between aneurysm volume, packing, and compaction in 145 cerebral aneurysms treated with coils. Radiology. 2004;231(3):653–8.CrossRefGoogle Scholar
  13. 13.
    Uchiyama N, Kida S, Nomura M, et al. Significance of volume embolization ratio as a predictor of recanalization on endovascular treatment of cerebral aneurysms with guglielmi detachable coils. Interv Neuroradiol. 2000;6(Suppl 1):59–63.CrossRefGoogle Scholar
  14. 14.
    Baxter BW, Rosso D, Lownie SP. Double microcatheter technique for detachable coil treatment of large, wide-necked intracranial aneurysms. AJNR Am J Neuroradiol. 1998;19(6):1176–8.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P, International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366(9488):809–17.CrossRefGoogle Scholar
  16. 16.
    Spetzler RF, McDougall CG, Zabramski JM, Albuquerque FC, Hills NK, Russin JJ, Partovi S, Nakaji P, Wallace RC. The barrow ruptured aneurysm trial: 6-year results. J Neurosurg. 2015;123(3):609–17.CrossRefPubMedCentralGoogle Scholar
  17. 17.
    McDougall CG, Spetzler RF, Zabramski JM, Partovi S, Hills NK, Nakaji P, Albuquerque FC. The barrow ruptured aneurysm trial. J Neurosurg. 2012;116(1):135–44.CrossRefPubMedCentralGoogle Scholar
  18. 18.
    Koivisto T, Vanninen E, Vanninen R, Kuikka J, Hernesniemi J, Vapalahti M. Cerebral perfusion before and after endovascular or surgical treatment of acutely ruptured cerebral aneurysms: a 1-year prospective follow-up study. Neurosurgery. 2002;51:312–25.CrossRefPubMedCentralGoogle Scholar
  19. 19.
    Delgado FA, Andersson T, Delgado FA. Clinical outcome after surgical clipping or endovascular coiling for cerebral aneurysms: a pragmatic meta-analysis of randomized and non-randomized trials with short- and long-term follow-up. J Neurointerv Surg. 2016;6Google Scholar
  20. 20.
    McDougall CG, Johnston SC, Gholkar A, Barnwell SL, Vazquez Suarez JC, Massó Romero J, Chaloupka JC, Bonafe A, Wakhloo AK, Tampieri D, Dowd CF, Fox AJ, Imm SJ, Carroll K, Turk AS, MAPS Investigators. Bioactive versus bare platinum coils in the treatment of intracranial aneurysms: the MAPS (Matrix and Platinum Science) trial. AJNR Am J Neuroradiol. 2014;35(5):935–42.CrossRefPubMedCentralGoogle Scholar
  21. 21.
    Koebbe CJ, Veznedaroglu E, Jabbour P, Rosenwasser RH. Endovascular management of intracranial aneurysms: current experience and future advances. Neurosurgery. 2006;59(5 Suppl 3):S93–102.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, Martin N, Vinuela F. Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg. 2003;98:959–66.CrossRefGoogle Scholar
  23. 23.
    Takigawa T, Suzuki K, Sugiura Y, Suzuki R, Takano I, Shimizu N, Tanaka Y, Hyodo A. Thromboembolic events associated with single balloon-, double balloon-, and stent-assisted coil embolization of asymptomatic unruptured cerebral aneurysms: evaluation with diffusion-weighted MR imaging. Neuroradiology. 2014;56(12):1079–86.CrossRefPubMedCentralGoogle Scholar
  24. 24.
    Raymond J, Roy D. Safety and efficacy of endovascular treatment of acutely ruptured aneurysms. Neurosurgery. 1997;41:1235–46.CrossRefPubMedCentralGoogle Scholar
  25. 25.
    Molyneux AJ, Clarke A, Sneade M, Mehta Z, Coley S, Roy D, Kallmes DF, Fox AJ. Cerecyte coil trial: angiographic outcomes of a prospective randomized trial comparing endovascular coiling of cerebral aneurysms with either cerecyte or bare platinum coils. Stroke. 2012;43(10):2544–50.CrossRefPubMedCentralGoogle Scholar
  26. 26.
    White PM, Lewis SC, Gholkar A, Sellar RJ, Nahser H, Cognard C, Forrester L, Wardlaw JM, HELPS trial collaborators. Hydrogel-coated coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms (HELPS): a randomised controlled trial. Lancet. 2011;377(9778):1655–62.CrossRefPubMedCentralGoogle Scholar
  27. 27.
    Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, Lamoureux J, Chagnon M, Roy D. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke. 2003;34:1398–403.CrossRefGoogle Scholar
  28. 28.
    Johnston SC, Dowd CF, Higashida RT, Lawton MT, Duckwiler GR, Gress DR, CARAT Investigators. Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the cerebral aneurysm Rerupture after treatment (CARAT) study. Stroke. 2008;39(1):120–5.CrossRefPubMedCentralGoogle Scholar
  29. 29.
    Mascitelli JR, Moyle H, Oermann EK, Polykarpou MF, Patel AA, Doshi AH, Gologorsky Y, Bederson JB, Patel AB. An update to the Raymond-Roy Occlusion Classification of intracranial aneurysms treated with coil embolization. J Neurointerv Surg. 2015;7(7):496–502.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Kyle M. Fargen
    • 1
  • Jasmeet Singh
    • 2
    • 3
  • John A. Wilson
    • 4
  • Stacey Q. Wolfe
    • 4
  1. 1.Department of Neurological SurgeryWake Forest University, Wake Forest Baptist HealthWinston-SalemUSA
  2. 2.Department of Radiology and NeurosurgeryWake Forest University, Wake Forest Baptist HealthWinston-SalemUSA
  3. 3.Bowman Gray CenterWinston-SalemUSA
  4. 4.Department of Neurological SurgeryWake Forest University, Bowman Gray CenterWinston-SalemUSA

Personalised recommendations