When is Aneurysm Stenting the Right Treatment Option?
When Aneurysm Stenting Is the Right Option – NJ Brain & Spine Aneurysm Guide
A brain aneurysm ruptures every 18 minutes in the U.S., according to the Brain Aneurysm Foundation, meaning 30,000 Americans experience the health emergency every year.
A range of brain aneurysm treatment options exist, including the minimally invasive aneurysm stenting. In fact, a meta-analysis of stent-assisted coiling determined that in 98% of 976 patients the stents were placed successfully. The same research shows that for half of patients the aneurysm was sealed off completely right after the procedure and even more were closed over time.
Whether aneurysm stenting is the right option depends on the aneurysm’s shape and size, the potential for rupture, and the patient’s general health. It is most often chosen for wide-neck or complex aneurysms, aneurysms in challenging locations, or in patients who are not ideal candidates for open brain surgery.
What is aneurysm stenting?
Aneurysm stenting includes stent-assisted coiling and, in some cases, flow-diverting stents. It is a minimally invasive endovascular procedure in which a tiny metal stent is placed inside the blood vessel to support coils or redirect blood away from the aneurysm. The stent acts as a scaffold to help keep coils inside the aneurysm and to preserve the normal vessel channel so blood continues to flow through the parent artery. In many cases, aneurysm stenting allows doctors to treat aneurysms that would be difficult or unsafe to secure with coils alone or with open surgery.
How stent-assisted coiling works
During stent-assisted coiling, a catheter is inserted through an artery in the groin and navigated through the blood vessels up into the brain under X‑ray guidance. Once the catheter reaches the vessel that contains the aneurysm, the stent is deployed across the opening of the aneurysm to redirect blood flow. Tiny platinum coils are placed into the aneurysm to reduce blood flow into the aneurysm, promote clotting, and exclude the aneurysm from blood circulation to reduce the risk it will rupture.
When stenting is the right choice
Common scenarios where aneurysm stenting or stent-assisted coiling approaches are favored include:
- Wide-neck or complex aneurysms. The opening of the aneurysm is broad and coils would be unstable or prone to falling back into the parent vessel without a stent scaffold.
- Aneurysms at weak spots. Arteries can split so preserving flow to multiple branches while safely filling the aneurysm requires the structural support of a stent.
- Large, giant, or recurrent aneurysms. Those that have not been fully controlled with prior coiling or other treatments require a stent or flow diverter to provide more durable reconstruction.
- Patients with higher surgical risk. Whether the risk is for open surgery or clipping, minimally invasive aneurysm stenting is safer, particularly for aneurysms in deep or surgically difficult locations, or in older adults or people with significant medical conditions.
For many patients with unruptured aneurysms that meet these criteria, a stent-assisted approach is an important option to discuss with a neurointerventional team at New Jersey Brain & Spine.
Benefits compared with clipping or coiling alone
Aneurysm stenting offers several potential advantages compared with traditional open surgery and, in select cases, compared with coiling without a stent.
- Brain aneurysm is less invasive than clipping, because the aneurysm is reached through blood vessels rather than through a skull opening, which can mean less pain and a shorter recovery (1 week vs. 4-6 weeks for open surgery microsurgical clipping).
- For wide-neck or complex aneurysms, stent-assisted coiling can make endovascular treatment possible when coils alone would be unstable or unsafe.
- Aneurysm stenting helps preserve important branch vessels while effectively excluding the aneurysm from circulation.
Who is a good candidate for cerebral aneurysm treatment options?
A good candidate for aneurysm stenting generally has an aneurysm whose shape or location makes it difficult to safely treat with coils alone, and vessels that are healthy enough to permit stent placement. The patient also needs to be able to take antiplatelet medications to promote clot formation and attend follow-up visits and imaging.
Typical characteristics of good candidates include:
- Unruptured, wide-neck or complex aneurysms, particularly those at vessel bifurcations, side branches, or in areas that are risky to reach with open surgery.
- Patients whose age or medical conditions make open surgery higher-risk, but who can tolerate blood thinners.
- Patients with recurrent aneurysms after prior coiling, where a stent could stabilize coils and improve long-term closure of the aneurysm.
Patients with recent major bleeding, inability to take antiplatelet drugs, or severe vessel disease that makes stent navigation unsafe may not be appropriate candidates, and specialists at New Jersey Brain & Spine may recommend other treatments.
Case Study: Michele Blum’s Aneurysm Journey
Michele Blum is a New Jersey-based community theater actress who lights up every room she walks into with vibrant energy. But in 2012, Michele experienced a different kind of drama when she was admitted to the emergency room after suffering a severe bleed in her brain.
“Any time a person suffers a ruptured brain aneurysm it’s a matter of life and death,” says Reza J. Karimi, MD, FAANS, FACS, who specializes in neurotrauma including aneurysm. “Michele had four separate brain aneurysms.”
Once Dr. Karimi and the specialists at New Jersey Brain & Spine got a full picture of what was going on with the arteries of her brain, they decided that the only way to treat her was surgery. Her fate uncertain, Michele’s family was painfully aware of the peril she was in. Her daughter started a journal. “My most beautiful mom. Today was a really good day, after four or five days of being lethargic, you finally started to come around…”
Michele also knows it wasn’t just her family looking out for her. “They didn’t think I was going to make it,” she says, “but they didn’t know Dr. Karimi.”
Watch the full case study here
Options if aneurysm stenting is not suitable
If aneurysm stenting is not the right option, other well-established treatments are available, and the neurovascular team at New Jersey Brain & Spine will explain which is safest and most effective for the specific patient.
Common alternatives include:
- Microsurgical clipping: Open brain surgery to place a small metal clip at the base of the aneurysm, physically closing it off from the artery. This approach can offer very durable results for many well‑located aneurysms but requires a longer recovery.
- Endovascular coiling alone: For narrow-neck aneurysms or certain locations, coils can be placed without a stent, which may be preferable for patients who need to avoid long-term blood thinners.
- Flow-diverting stents alone: Specialized flow-diversion devices are used without coils to redirect blood away from the aneurysm, promote gradual aneurysm closure, and heal the blood vessel.
- Observation: In select small, low‑risk brain aneurysms, particularly in patients with high procedural risk, New Jersey Brain & Spine specialists may recommend careful imaging surveillance without immediate intervention.
What to expect before, during, and after cerebral aneurysm treatment options
Before aneurysm stenting, patients undergo detailed testing to map the aneurysm and surrounding vessels. Tests can include a CT scan, MRI, cerebral angiography, or cerebrospinal fluid (CS) analysis. Patients with unruptured aneurysms are commonly started on dual antiplatelet medications days or in some cases weeks before the procedure.
The minimally-invasive aneurysm stenting procedure is typically performed under general anesthesia. A neurointerventional surgeon threads catheters through the arterial system to the brain, deploys the stent across the aneurysm, and then fills the aneurysm with coils or uses a flow-diverting strategy depending on the case. Most patients stay in the hospital for a short observation period, often only one to two days if there are no complications.
After discharge, patients remain on antiplatelet medications per the specialist’s plan. Follow-up vascular imaging is done at set intervals to confirm that the aneurysm is adequately closed and the stent remains open. Long-term follow-up is important because changes can occur gradually over time, and early detection of any recurrence or vessel narrowing allows for timely management.
Why choose NJ Brain & Spine for aneurysm treatments
For patients in New Jersey with an unruptured aneurysm or a complex aneurysm that may benefit from aneurysm stenting, New Jersey Brain & Spine specialists provide essential evaluations, diagnosis, and treatment plans. Cerebral aneurysm treatment includes reviewing detailed imaging, discussing clipping, coiling, stenting, and flow-diversion options, and personalizing the plan based on anatomy, overall health, and patient preferences.
New Jersey Brain & Spine’s neurovascular specialists help determine whether aneurysm stenting is appropriate, explain the need for antiplatelet therapy and follow-up, and coordinate care so that patients and families clearly understand the tradeoffs of each option. If you or a loved one has been diagnosed with a brain aneurysm, scheduling a consultation with a New Jersey Brain & Spine specialist is an important step toward choosing the safest and most effective treatment path.
Contact our care team for an evaluation and specialist care.
Frequently Asked Questions:
What are meningioma, astrocytoma, and glioblastoma?
Meningioma, astrocytoma, and glioblastoma are the most common primary brain tumors, and specialists at New Jersey Brain & Spine help patients and families understand the important differences between them.
What are the differences between meningioma, astrocytoma, and glioblastoma?
Meningiomas are usually benign, small, and slow growing. Astrocytomas arise within brain tissue and vary by grade: Grade 1 tumors often respond well to surgery or surveillance; Grade 2 tumors may require surgery, radiation, chemotherapy, or both; and Grades 3–4 may also involve targeted therapies or clinical trials. Glioblastoma is one of the most aggressive primary brain tumors, grows quickly, invades surrounding tissue, and tends to recur.
How do the differences impact patient care?
Understanding the type and grade of tumor is essential for guiding treatment. A benign meningioma may be monitored without immediate surgery, a low-grade astrocytoma may be surgically removed with good quality of life, and a glioblastoma requires rapid, aggressive treatment and coordinated multidisciplinary care.
When should patients seek medical care for a brain tumor?
Because early diagnosis and treatment are important, patients should consult with a New Jersey Brain & Spine specialist immediately if they experience new or worsening headaches, seizures, weakness, vision loss, coordination problems, or personality changes.
Why select New Jersey Brain & Spine for treatment of meningioma, astrocytoma, and glioblastoma?
New Jersey Brain & Spine’s specialists help patients and families choose the best care plans, whether monitoring benign meningiomas or treating aggressive glioblastoma that requires immediate action. Their state-of-the-art facilities and expert teams personalize treatment and follow-up based on each patient’s diagnosis, needs, and goals.
