I am currently investigating all the pros and cons of clipping versus stent-assisted coiling in preparation for my second neurosurgeon visit on May 30th. Both of my options are technically difficult according to the surgeon but one of the things that appeals to me about the clipping versus the stent-assisted coiling is the definitive nature of the clipping treatment. Once the clips are placed and the aneurysm is secure, recovery begins and follow up is in the immediate post-op period. If things don’t go well, you know up front and deal with it then and there.
The stent-assisted coiling is more of an in-and-out procedure but it requires anti-platelet therapy (up to 9 months for double anti-platelet therapy and aspirin thereafter) and imaging follow up with a significant delayed stroke risk. My question to you is who does the follow up for that? Who manages the anti-platelet therapy and imaging? How well do they coordinate with other doctors if you have co-morbidities? I have already experienced difficulty with asking questions and arranging follow up after the first consultation at Mayo and I am wary about long-term follow up in our healthcare system in general. The right hand doesn’t seem to know what the left hand is doing most of the time and I cannot just run up to Mayo since I do have a full-time job and a three-year-old at home.
I appreciate any input you can provide on how the follow up was managed after your procedures. Any plusses or pitfalls for one procedure over another? Any difficulties with traveling to get the procedure and then being “lost to follow up”?
Hi Jennifer,
I have had 3 aneurysms treated with pipeline stents. The first one was a quick recovery; a little tired and a post procedure headache. The last two, done at the same time really messed me up. They were originally going to use two coils and a stent on the last one but decided they could do it with a longer stent. Lost sense of smell and taste, a nerve exploding headache, no short term memory. And of course an emotional mess. Took about a year to fully recover from this. I feel like I’m 90 -95% recovered most of the time. Now for my last one they want to clip because they will have to go through the long stent on the 2 aneurysms to get to this last aneurysm.
So, I am also looking for answers about clipping. The recovery rates, loss possibilities, unknowns…
If just a pipeline was an available option for me I am sure I would select that. I am not excited about coiling due to shrinkage.
As to insurance my Premera was going to cover the pipeline and coiling and did cover the pipeline. They have also covered all of my angiograms.
Take care, Autumn
Hi Autumn,
Thank you for replying. There seems to be such a wide variety of outcomes for every procedure. I am glad you are 90-95% recovered now after such a rough ride the second go-round. It seems that the medical profession is moving more and more to the endovascular procedures as a “less invasive” option, but as seen in the letter from the FDA that I posted it is also a very serious procedure with significant risks. Those of us with un-ruptured aneurysms have difficult decisions to make regarding treatment because the risk of rupture is impossible to know and the risks of the procedures are significant. To be honest, all the options scare me and coming to terms with that has been difficult. I am afraid of making the wrong choice and negatively impacting my family. If I do nothing and it ruptures, they will have to deal with that and if I choose a procedure that causes debilitating outcomes, they will have to deal with that too. It is very hard and, as usual, I am probably over thinking it. Information is power, though, and I thank you for taking the time to respond.
Take care,
Jennifer
Hi Jennifer, I opted for stent-assisted coiling for my aneurysm. I am being followed up the the doctor who did the coiling with MRI’s with dye every three months. I am on baby aspirin and plavix. The doctor who did the procedure is also following up with regard to the blood thinners. I will need more coils because I have a wide necked aneurysm and the coils have started to compact. Because I live in Ontario,Canada, both the coiling procedure and the clipping procedure are totally covered by OHIP. The doctor who did the procedure is part of a team with a neurosurgeon so the results of the MRIs etc. are discussed by the team. So the team will decide when I will have the next procedure. Stent-assisted coiling was better for me (I am 74) as it is less invasive. If I were younger, I likely would have opted for clipping. The procedure was done in Dec. So far I had 1 appointment in Jan. without an MRI and one in March with an MRI. The next appointment with an MRI will be in June. I am satisfied with the way the follow up is being done. Wishing you all the best with whatever procedure you chose. Ida
I had clipping done 16 years ago at Emory in Atlanta. The coiling procedure had not been around too long so it kind of made my decision a little easier. If you call having a crainotomy easier. lol Recovery was not easy but doable. I just went back to have staples removed and never went back to Emory. I don’t really go to a neuroloigst on a regular basis. I see my primary care physician yearly. Every procedure has diffferent outcomes for each individual I’m sure. I didn’t have any complications and live a pretty normal life. Take care of a 3 yr old grandchild every day. I’m 60 now and just try to take care of myself. Hope this helps. I’ll be glad to answer anymore questions. robyn
We have a population of about 160,000 in the county I reside in. We are about 70 miles from my Neurosurgeon. She definitely does not know what programs are available to me in my county. Unless it’s surgical issues, she relies on my PCP. The PCP might be lost as to what to do if they haven’t dealt with issues you present as my first one was upon release from hospital. I sought out speech therapy and returned to a short course of physical therapy. I just had to ask my Neurosurgeon. The PCP I have now is wonderful, she doesn’t think I need another Neurosurgeon like the previous PCP and she can readily suggest a specialist if needed and give the referral!
For the follow ups that deal specifically with my ruptured aneurysm, the Neurosurgeon has the tests ordered. I do them at her hospital. This is not on the side effects caused by the SAH, just the aneurysm. In fact my PCP and I discussed having all needed MRAs done at the hospital my Neurosurgeon is at so the imaging is all at one place.
I would recommend going in and speaking face to face with your PCP and asking about what they can refer you to if anything is needed. This way they also have a heads up and can do some research for services in your city or county.
