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PubMed This is a summary of 22 peer-reviewed journal articles Updated
Neurosurgery

Securing the Aneurysm: Treatment Options and Decisions

At a Glance

The top priority after a brain aneurysm ruptures is securing it to prevent a deadly second bleed. The two standard treatments are endovascular coiling (a minimally invasive catheter procedure) and microsurgical clipping (open brain surgery). The best choice depends on the aneurysm's specific anatomy.

Once a brain aneurysm has ruptured, the highest priority for the medical team is to secure it [1]. This means sealing off the weak spot so that blood can no longer enter it, which prevents a second, often more dangerous bleed (known as rebleeding) [2][3].

The decision on how to secure the aneurysm is complex and depends on the aneurysm’s size, shape, and location, as well as your overall health [4][5].

Primary Treatment Options

There are two main “standard of care” methods used to secure a ruptured aneurysm. Both are performed while you are under general anesthesia.

1. Endovascular Coiling

In this procedure, a specialist (neuro-interventionalist) inserts a thin tube called a catheter into an artery in your groin or wrist and threads it up to the brain [6].

  • How it works: Tiny platinum coils are pushed through the catheter into the aneurysm [7]. These coils fill the space, causing the blood to clot and sealing the aneurysm from the inside [8].
  • Benefits: It is less invasive than open surgery and has been associated with better health-related quality of life and faster short-term recovery for many patients [9][10].
  • Considerations: Large or wide-necked aneurysms may be harder to treat with coils alone and may have a higher risk of recurring (opening back up) over time [11].

2. Microsurgical Clipping

This is a traditional neurosurgical procedure that requires a craniotomy (temporarily removing a small piece of the skull) [10].

  • How it works: A neurosurgeon uses a high-powered microscope to locate the aneurysm and places a tiny metal clip across its “neck” or base [12]. This physically blocks blood from entering the aneurysm [13].
  • Benefits: Clipping is often considered a more “permanent” fix with a lower rate of the aneurysm recurring [14]. It may also be the better choice if there is a large blood clot that needs to be removed at the same time [12].
  • Considerations: It is a more invasive surgery and may carry a slightly higher risk of short-term cognitive changes (like memory issues) depending on the aneurysm’s location [15][16].

Flow Diversion: A Note on Complex Cases

You may read about a treatment called a flow diverter, which is a specialized mesh stent placed across the opening of an aneurysm [17]. It is important to know that flow diversion is primarily used to treat unruptured aneurysms [18].

In the acute phase of a ruptured aneurysm (an aSAH), flow diverters are an absolute last resort [18]. This is because the stent requires you to take dual antiplatelet therapy (powerful blood thinners) to keep it from clogging [19]. Taking blood thinners immediately after a brain bleed carries a catastrophic risk of a fatal hemorrhage, especially if you also need an external ventricular drain (EVD) to manage brain pressure [20][19]. If your surgical team suggests a flow diverter for a ruptured aneurysm, it means that clipping and coiling are medically impossible, and they will meticulously monitor your blood clotting levels in the ICU to mitigate the risk [20].

How the Choice is Made

Your surgical team will look at several factors to determine the best approach for you:

  • Aneurysm Anatomy: Is the “neck” wide or narrow? Is it in a location easily reached by a catheter or by surgery? [12][21]
  • Clinical Grade: How severe were your initial symptoms? Poor-grade patients may sometimes benefit from the less invasive nature of coiling [22].
  • Patient Factors: Your age and other health conditions (like heart disease) play a role in which procedure is safer [4].

Regardless of the method, the goal is the same: to protect the brain from further bleeding so that the focus can shift toward recovery. Learn about the next phase of care in Navigating the Neuro-ICU.

Common questions in this guide

What is the difference between coiling and clipping for a brain aneurysm?
Coiling is a minimally invasive procedure where a catheter is used to fill the aneurysm with tiny coils from the inside. Clipping is an open surgery where a neurosurgeon temporarily opens the skull and places a small metal clip across the base of the aneurysm to stop blood flow.
Why do doctors need to secure a ruptured brain aneurysm?
A ruptured aneurysm must be secured immediately to prevent it from bleeding again. A second bleed, known as rebleeding, is highly dangerous and can cause severe brain damage or be fatal.
Which brain aneurysm treatment is better, coiling or clipping?
The best treatment depends on the aneurysm's size, shape, and location, as well as your overall health. Coiling is less invasive and offers a faster short-term recovery, while clipping is often considered a more permanent fix with a lower chance of the aneurysm reopening.
Can a flow diverter be used for a ruptured brain aneurysm?
Flow diverters are typically used for unruptured aneurysms and are only an absolute last resort for ruptured ones. They require strong blood thinners to keep the stent open, which carries a catastrophic risk of fatal bleeding immediately after a brain hemorrhage.
Will an aneurysm come back after coiling?
Aneurysms treated with coiling have a slightly higher risk of reopening over time compared to those treated with clipping. Because of this, patients who undergo coiling often require more frequent follow-up brain scans to monitor the treated area.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on the location and shape of this aneurysm, why do you recommend coiling or clipping over the other option?
  2. 2.How many of these specific procedures do you perform each year, and what is your center's volume for aSAH?
  3. 3.If we choose coiling, what is the risk of the aneurysm recurring or needing a second procedure later?
  4. 4.If we choose clipping, what are the specific risks to my memory or cognitive function based on where the aneurysm is located?
  5. 5.Does the presence of any blood clots in the brain make surgical clipping a better choice for me?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

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This information explains standard treatments for ruptured brain aneurysms for educational purposes. Always rely on your neurosurgical team to determine the safest surgical approach for your specific aneurysm.

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