Large aneurysms may benefit from coil.

Sizable brain aneurysms can make for high-risk surgery in some people with these dangerous blood-vessel bulges. Elderly or frail patients with aneurysms 2 centimeters or more in diameter often respond well to a less invasive technique, doctors in Austria report in the October NEUROSURGERY.

By threading a tube called a catheter through a patient's bloodstream, doctors can deliver tiny platinum coils to the aneurysm. Released at the trouble site, the coils fill the bulge and trigger formation of blood clots, which seal off the aneurysm. When successful, this prevents the artery or vein from rupturing.

Andreas Gruber and his colleagues at the University of Vienna Medical School attempted the technique in 30 patients with large aneurysms who were deemed poor surgery candidates. Untreated, such patients usually die within 2 years. However, 40 months after the platinum-coil procedure, only five patients had died, one from an unrelated cause. The researchers found that the aneurysm had subsided in 22 of the remaining patients and was unchanged in the other three.

This success rate is similar to that seen with traditional surgery, in which physicians pinch off the aneurysm with metal clips.

Gruber says that while the coil approach may be safer, surgically placed clips remain a more permanent fix. The coil procedure should be reserved for people with large aneurysms and for whom surgery poses high risk, he says.