Brain aneurysm treatment. Clip, coil, or stent? How to choose best therapy for intracranial aneurysm? 4

Brain aneurysm treatment. Clip, coil, or stent? How to choose best therapy for intracranial aneurysm? 4

Brain aneurysm treatment. Clip, coil, or stent? How to choose best therapy for intracranial aneurysm? 4

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Clipping of brain aneurysm has classically been considered a definitive treatment. New brain aneurysm coiling options and even stenting of brain aneurysms result in better long term outcomes. Leading neurosurgeon. Let’s talk about treatment of brain aneurysms. Dr. Anton Titov, MD. There is obviously an endovascular “coiling" of brain aneurysms. Dr. Mika Niemela, MD. Yes. There is also a classical open brain surgery "clipping" of brain aneurysms. But the coiling of brain aneurysm might not be a permanent treatment of the brain aneurysm. We recognize that coiling of aneurysm is less invasive. Dr. Anton Titov, MD. You have done research regarding clipping of brain aneurysms that were previously coiled. How do you compare the treatment options of coiling and clipping of brain aneurysm? Some brain aneurysms need to be clipped after they were coiled. Dr. Mika Niemela, MD. It depends on the age of the patient. For younger patients maybe it is better to clip brain aneurysm. It is especially true if brain aneurysm is located in the anterior blood circulation. Clipping of unruptured brain aneurysm in the anterior circulation is perhaps better. It depends on the other risk factors. Patient could be elderly. Patient could have poor health because of other diseases. Dr. Anton Titov, MD. Then brain aneurysm coiling is less risky. Best method of brain aneurysm treatment also depends on the form of the aneurysm. Dr. Mika Niemela, MD. Aneurysms can be clipped, coiled, or stented. Or we can apply a flow diverter endovascularly. Treatment choice depends on the shape and size of the brain aneurysm. But that matters less today. Because we use modern techniques of brain aneurysm treatment. Dr. Anton Titov, MD. But in younger patients microsurgery has more permanent results than endovascular coiling or stenting of brain aneurysms. We have analyzed our case series of treatment of brain aneurysms. Dr. Mika Niemela, MD. We clipped brain aneurysms that have had been previously coiled partially. But today the techniques of endovascular treatment of brain aneurysms are better. They have evolved so much that very rarely do we have to clip a partially coiled brain aneurysm. Because you can add coils later to the brain aneurysm. Or you can put a stent or flow diverter to the brain aneurysm. That has become less of a problem than we thought it would be. The initial decision whether to coil or to clip a brain aneurysm could be the final decision for that particular patient? Yes, exactly,. Then you can continue with the same technique. Sometimes you need to add more coils later to the brain aneurysm. A neurosurgeon can coil a brain aneurysm. Neurosurgeon does not necessarily need to clip a brain aneurysm later. Dr. Anton Titov, MD. How do you assess the patients who had brain aneurysm coiled? How do you know whether they need some additional coils put in? Dr. Mika Niemela, MD. We follow the patients with digital subtraction angiography, DSA. We also perform MRA, magnetic resonance imaging angiography. It depends on how the brain aneurysm behaves during our follow-up with a patient. We always follow these patients carefully.

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