Follow-up procedures for unruptured, coiled aneurysms

I have 3 unruptured aneurysms. One was coiled and stented about 4 mos ago, so I'm coming up on my 6month follow up femoral-artery angiogram. My surgeon, plus a second-opinion surgeon both do 6mos angios as follow ups.

However, I had my daughter at her pediatric neurologist today, and he told me emphatically to insist on an MRA at the 6mos mark, and only then, if the surgeons feel it's 100% essential, to do the angio. His feeling was that angios do carry risk, and that MRI's are excellent, and that surgeons often get aggressive w/ testing/procedures.

So - I'm left confused. I don't want to be stupid and cause more risk for myself, but at this point I'm not sure where the biggest lies ---- with the potential for complications from the angiogram, or with the potential for skipping the angio and relying on MRA, which my surgeon feels isn't as good.

Have any of you been followed up WITHOUT femoral angios, and only MRA's????

I'd love nothing more than to avoid another angio!



Hello Jennifer~

I had a rupture annie that was coiled a little over a year ago with a second coiling on the same location a month later. I have had two follow up MRI/MRA's only to check since there is still a remnant on the neck of the annie. My docs feel that the MRI/MRA provide excellent images and can even tell me that my remnant is 2 mm and not changing. I feel confident to rely on the MRI/MRA's and would feel so much more unsure if I had to undergo the angio for evaluation purposes. (Especially since I have to go every six month for re-evaluation on this to ensure that no changes are occurring.). I go back in another month or so for another MRI and then hopefully they will extend my time to a one year or two year wait and watch - to be followed with another MRI only.

Hi Jennifer... surgeon (2 of them) want follow~up in June and then again in 6 months with angio~gram...told me this b4 coiling...right now...I have my neurologist working with me...(2 different university affiliations)....and he is in agreement...I have been suffering for the past 2 weeks with swelling around right eye and temple...possible leak...told only way they can tell for sure is through I am at a loss with your information...I feel so much for all of us...because so much different information...not to mention, I am finding so many problems with coiling...that I am not so here I poor thing...not any help to you...just writing a book...I think alot has to do with the "faith" we have in our surgeons and God...let us know what you decide...we are so close in coiling...that I feel a bond...Hugs sweetie...Colleen

Hey Jennifer. I did not have an angio before my clipping surgery, after surgery as part of follow up, or recently when I was having headaches. Nothing but CT’s. My surgeon said the CT gave him a perfectly clear picture of what was going on. Since he’s the guy whose picture is on the main brain aneurysm foundation site and started the foundation I figured I’d be ok. :slight_smile: The first surgeon I saw wanted to do an angio before. I only need to do a CT every 5 years and we know there is another one still in there.

I was told by my doc he wants my 6 month follow up as an anio to ensure the stent is ok. After that we can do MRI/MRA. But the first time the angio shows the position of the stent better than the other tests. And since I feel my doc did an absolute amazing job with me, I am not questioning him and I'm more than willing to go through with it.

I hope you get the answers you want.

To me it is a no brainer (no pun intended) if your primary Dr. for your aneurism says angio then angio it should be. IMO angio is the gold standard test and the sure-fire way to see anything going on.

Certainly monitoring with MRI is suitable when the "big giant brains" who treat the nasty little thing(s) feel it is stable enough.

I'm not a Dr. and actually not very smart so please be reminded above is just my opinion.

Thanks everyone. I have scheduled the angio (first f/u) for April 14 - having it on the calendar is scary. I'm both scared of the procedure, and the results. I have 3 that they're checking - one coiled w/ stent, one just above that that's too small to coil but is covered by the stent - so hope is that it clots itself off, and one on the other side that's 2-3mm and was unable to be coiled b/c of size. I'm starting to have a sense that the results will be okay, but am a chicken about the procedure - plus some PTSD about being back at the hosp, in the same room where they did the original surgery. But, I check in at 6:30, procedure at 8 - im told it's 45 min to an hour, and hopefully home by noon - which makes it feel a little less like a big deal.

My neurologist couldn't believe that my daughter's neurologist even suggested MRA instead of angio, and the two surgeons I consulted w (one before and one after the coiling) both do angios for f/u, so I know I'm making the right choice - it just really threw me for a loop to have it suggested (emphatically) that there was no reason for taking the (slight) risk of an angiogram.

Thanks again - and if anyone else wants to pipe in, I'm still curious about other doctors' follow up plans - not changing my plan, but curious how others approach it.


Hi Jennifer…b4 my coiling…both Neurosurgeon’s told me that 6 mos after coiling I would have an angiogram and again 6 months after that…I go June…it was scheduled after my 6 week checkup after coiling…My Neurologist … well…what can I say…to me…he is the best…he has helped me and hubby more than any Doctor…my entire 46 years…and he told me … it is imperative that I have the angio’s as checkup’s from the coiling…and once they clear me…there will be no questions…like you…I am scared, but will have to “bite the bullet”…and have faith in God and the Doc’s…and know that you and I will make it through…because remember … you have my prayers…Gotcha in my thoughts…Hugs Colleen

Jennifer, I'm truly puzzled. My neurosurgeon said MRI's were forbidden because the coil could be pulled out of place. The types of materials used in the coils varies, but--geez--can they are metal. Can an MRI or any kind, with or without contrast be the thing you want to do without questioning it?

This should be something I think should be clarified with the surgeon. It took me awhile to figure out that neurosurgeons first have to be neurologists. Duh! you say. But, it did cause me to rank opinions. The surgeon put the coils up there and he probably is the one that most understands how they work and what needs to be done after the surgery. And, he's got the most experience.

When my surgeon performed the angio he was looking to see if blood was still able to gather in the aneurysm. Gathering blood would eventually cause a clot and thus a stroke, not something I wanted to mess with. Since the surgeon could only fill the annie up to 30% with coils (it's structure and some other things prohibited filling it further), he was checking to see how the coils were working. They were allowing enough blood into the annie that a major stroke was a significant risk. So, there was reason for the angio. How do I know all this? Because I asked. Ask--that's the key.

Thanks Robin -

THe kind of stent I have (don't have the card in front of me telling the kind) is completely safe for all strengths of mri/a machines. In the past, some were not, but mine is a very current model, having only been inserted several mos ago!

I've decided to stick w the original advice of angio - scheduled now for April 14. It was just a shocker to hear another doc so strongly advocate for NO angio as f/u. MY neurologist, however, was shocked that this other neurologist (my daughter's) suggested no angio - said angio as follow up is the gold-standard.

Thanks so much for writing!