Unassisted Aneurysm Coil Embolization

Abstract

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.