Treatment options?

I had an angio last week that confirmed an unruptured 4-5 mm saccular aneurysm involving the left internal carotid artery @ the junction of its ophthalmic and supraclinoid segments. The doctor said I'm lucky in that its size, shape, & location allow treatment options, and a team of interventional radiologists and neurosurgeons will soon meet and make a recommendation.

I know there are pros & cons of any treatment & have read about clipping & coiling (perhaps combined w a Pipeline stent, since mine has a broad neck).

I feel absolutely fine now, (However, I still occasionally have the sensation that my eyelid is twitching, which they've told me is unrelated to the aneurysm but is the reason I went to the doctor in the first place!)

Please tell me---is there any reason to even consider clipping when there is a less invasive alternative? I'm scared to death of stroke and some of the other side effects I've read about, but I don't want to risk watching & waiting too long because my Dad died of a ruptured aneurysm when he was the same age I am now.

Thanks for sharing your experiences & advice.

My husband has actually had both of these procedures done with the clipping just being a couple of weeks ago. He had a rupture in 2009 and they originally coiled his anyuerism but in his yearly angiogram they discovered that his anyuerism was again leaking a small amount and so we decided to have it clipped. Im not sure how common this is but according to his neurosurgeon explained to us that a clipping is much more permenant option espically for someone of his age being only 37. He told us that it is fairly common to have to have a coiling repeated. hope this helps and like I said this is only our expierence I know that there are many people here that have had coilings and seemed to do fine with it.

Hi Cecile,

Welcome to BAF.

The decision to coil, clip or do nothing is very individualized. Each option carries its own risk.

My recommendation is to use this site to get as much information as you can, ask questions of your doctors to become comfortable with your decision.

May God bless you with a competent medical team team and guide you in making your decision.

I had one aneurysm clipped in 1969 and I am watching 3 more (all more than 35 years old).


Hi and welcome To baf.
My annie was discovered in 2005 and they suggested do not doing nothing due to the small annie size.
I had my rupture at the beginnig of 2009, first coiled and one year later I received the PED pipeline flow diverter stent.
After the PED , I had several control and the annie seems to’ be’ fully occluded ( last control on september, 2011 ).
You have several optiion, the one I do not suggest is watching and waiting…
Take your time, get all the info and make your choise !
Take care of you,

Hi Cecelie...mine was I had no choices...told coiling and if they got in and coiling didn't work, they would clip me...I do hope you will be able to decide...I can only imagine how tought a decision...

Gotcha in my Thoughts...~ Colleen


I found out about my aneurysm about the same time I got a contract to write my first book. I decided to move forward even though my primary physician did not recommend it. The book requires research that needed to be done in remote areas of Washington and Oregon where if a rupture happened, I would not have access to the type of medical treatment I would require. As much as I was afraid of a stroke the other option was not tenable. I went in on Dec 22nd and walked out on Dec24th. I am now about 20k words into the book and will travel to Sequim, WA

and La Push, WA this weekend and feel pretty good. On Twitter I am @macdaddy_m if you want to follow and keep up w/my progress and book release. I am also known as and Wine Bytes on

Marc, cpongrats...I am delighted for you; and, of course memory slips (on those wickedly wired).

I am delighted to read this note from you. Please note th new one "Portland and W WA" group... Enjoy Sequim and do not la Push too hard...pray for decently reasonable weather for you.




Thanks for your sincere wishes for me and I hope you are fine. I have been in touch with Dawn. If it is raining and 50mph winds in La Push I will be happy. Like most chefs pushing too hard is all I know, but I always try to Eat well, Drink well and Live well!

thank you. I've been told clipping is often better for people under 40 as up to 30% o f the time aneurysms can re-occur.

thanks so much--the fact that you had one clipped that long ago and are watching for 35 years makea me humble.

thanks--the first doc I saw suggested the pipeline, I 'm glad to hear it has worked for you.

Wow. I appreciate your support and am glad to hear they can shift if one approach does not work as planned.

Congratulations! Your quick recovery gives me hope!

Hi Cecelie,

I can understand your concern in both procedures. I think you have to consider your age, past & current health conditions and anything that might be a big influence on what type operation to have.

I don't know where I got the courage to make my decision within my 1st hour in talking with my neurosurgeon, but I walked out having decided on a clipping. With my age (61) & at that time I was a cigarette smoker, I had my clipping done on 10/10/11. The reason I mention the 2 things is because you must look at your general health, your age and most of all what you feel comfortable in doing. As for post-op problems I think with clipping and coiling we pretty much go through the same problems, headaches, swelling, etc. I had no problem and very little pain with the operation. I would do it again if I had to. My ani was 7.5 mm and after the surgeon went in he found a smaller one, so he fixed that at the same time. I did not find this board till after my operation so I was totally unaware of all the post-op possibilites, which for myself probably was a good thing.

Think it through and do what you will feel secure in living with afterwards. Prayers to you and once you decide try not to question your decision. If I can answer any questions just email me. Blessings, Jeanne

Cecilie, I got so side-tracked by Marc's message; so pleased for his results; please accept my apology.

My common suggetion on ICAs is to track our great peers here w/Pipelines for a potential option to clip; not for coil/stents in the ICA. I wish I had had clip on ICA ...not coils and off-label stents to a non-wide neck aneurysm. Coils/stents are not commonly minimally invasive; tho highly marketed as such.

Other factors I have (non-professionally) researched is that coils are pre-determined to be less expensive w/reduced hospital time, etc. There are no stats on the number (percentage) of f/ups with added coil, cost of off-label stents, and, no dollar comparison of the high level of angio f/ups on coils. On the personal side of costs, travel can also be added based on locations.

Additionallyl angios have a high level of radiation for which there are no known stats for us.

Re: your eye twitching; please ask your neuros about the location of your aneurysm to the ophthalmic branch and your optic nerve and any of the other cranial nerves related to our vision muscle movements. there ae several other CNs related to pupil rotation and other functions.

Hope you get the great responses from your neuros and those of Pipeline implants here.

Many prayers for your best, and most comfortable, decision.



I am surprised that they told you they would clip if coiling did not work. I was told that clipping would leave me with brain damage (for those who don't know, we have annies in same location). Nice talkin' to you, Colleen. Have a great week,


Interesting, Pat. I have mused about the fact that the hospital billed my angio at $22,000 and my 3 day hospital stay, including 2 days of neuro ICU came up to $44,000. I have not received a bill for my Feb. angio, but I would presume it to be the same. And the 22,000 was only hospital, not labs, dr., etc. although I do wonder why they billed to read my arms and legs also (billed as separate line items). Plus, you are right - I will have them regularly from now on since I have coils and stent.

I have also tried researching on the radiation levels since I already have lots of tests w/rads to no avail. I did have some hair loss after my surgery, which was probably from the radiation level of 5 hours of surgery.


Hi Cecelie, I went back and forth between coiling and clipping. At first I only wanted coiling, then I wanted clipping. Then I heard about the Ped. At the end, for me, I only had one choice - coiling and stent because of the location. There are pros and cons on every type of annie fix - if you have a choice, that is great, but I don't think it is usually the patients option.

The most important thing for me is if you trust and feel comfortable with the doctor. My neurosurgeon told me at our 2nd appt. that we will be seeing a lot of each other over the years and if I would like to find another doctor, he would not be offended. I was very lucky - I really like him. I hope you get a decision soon. My annie is not close to anything to do with the eyes, so I never experienced that, although there are people on the forum who have had problems. Good luck - you will be fine.



We have so much more to discuss late; Somewhere in my files/squalor, I have stat data on the levels of rad that lists the cardio angio which is so high; it does not qualify the brain. If you browse rad - medical; or try down to Med Tests -Test refers to CT scans - Angiography (heart) and (head), but does not qualify arteriogrphy (angios) - heart and head...which run higher than CTs; then, of course, no ref to f/up coil /stent (or other) procedure(s). If you find what I missed; let me know! (Health Physics Society) notes Complete Exams; again the coronary, not Brain Angios... Merck Manual may be the file I want to relocate... their manual is hard for me to comrpehend... likely, just me...

Sherri, I hope we can get enough of our members / their families interested in that is essentially not addressed to us in our diagnostics for our decisions of coil vs clip. The devicamanias re-design / upgrade devices (hopefully, stock value) and not the procedures and related procedural requirements...

Will get back to you later of other things you have noted...


I feel silly for asking this, but I didn't know that there were other options available. My dr. has basically only ever mentioned coiling and stenting... never clipping. mine is small 4mm on my internal carotid. He said that the coiling is less invasive. I have an appointment in May , for another MRI, and to speak with my dr. to begin the process. He hasn't mentioned much about lifelong implications, followup testing... He has simply pretty much told me that because of my family history ( father had a subarach. hem. last summer, family history of strokes etc) that he believes I should get it taken care of. I am 25 year old, in excellent health. The radiation concerns me, I have been reading about it. Is the general consensus that clipping is better?

What a headache. (literally, and figuratively...)