Brain Aneurysm Without Open Surgery: Endovascular Coiling and Flow Diversion

A brain aneurysm is a bulge that forms on a weakened section of an artery wall inside the skull. Most are discovered incidentally — found during imaging for an unrelated complaint such as persistent headaches — before they rupture. When an aneurysm does rupture, it causes a subarachnoid haemorrhage, a life-threatening emergency. The good news is that modern endovascular techniques can seal an unruptured aneurysm before that event occurs, without the risks and recovery time of open brain surgery.

A Real Case: Six Months of Headaches, One Unexpected Finding

A 60-year-old woman had been experiencing recurring headaches and neck pain for six months. She attributed it to age and cervical spine wear. When the symptoms continued and intensified, her family persuaded her to see a neurologist. Imaging revealed a left internal carotid artery aneurysm — a bulge on the arterial wall inside the skull, under constant pressure from blood flow. With her long-standing hypertension adding further mechanical stress to the vessel wall, the risk of rupture was significant.

The patient was referred to the Neurosurgery Department at a partner hospital in Xi'an for assessment and treatment.

The Procedure: Coil Embolisation with a Flow-Diverter Stent

After cerebral angiography confirmed the precise location and dimensions of the aneurysm, Dr. Li Bo of the Neurosurgery team performed an internal carotid artery aneurysm coil embolisation combined with flow-diverter stent placement — without opening the skull.

The procedure works as follows:

1. A small puncture is made in the skin over the femoral artery at the top of the thigh — barely visible afterward.
2. A thin, flexible catheter is navigated through the arterial system, guided by real-time fluoroscopic imaging, until it reaches the aneurysm.
3. Platinum coils are deployed into the aneurysm sac, packing it and preventing blood from entering and pressurising the weak wall.
4. A flow-diverter stent (a fine, densely woven mesh tube) is placed across the neck of the aneurysm, redirecting blood flow back through the normal vessel and promoting gradual thrombosis and shrinkage of the aneurysm over time.

The patient was walking by the day after the procedure. Looking at the near-invisible puncture mark on her thigh, she and her family remarked: "Modern surgery is extraordinary."

Why Not Open Surgery?

Traditional craniotomy for aneurysm clipping involves opening the skull, retracting brain tissue to reach the aneurysm, and applying a metal clip across its neck. It is effective, but recovery is measured in weeks. Endovascular treatment achieves the same goal — isolating the aneurysm from the circulation — through an artery in the leg. Hospital stays are typically one to three days. Recovery is substantially faster.

For many aneurysms, particularly those on the internal carotid artery or basilar artery, endovascular access is technically superior to the open surgical route.

Who Is at Higher Risk of an Undetected Aneurysm?

The following groups have an elevated baseline risk of cerebrovascular abnormality and should consider proactive imaging:

• People with long-term hypertension
• Those with a family history of stroke, brain haemorrhage or cerebral aneurysm
• Anyone with frequent, severe or recurrent headaches — particularly those that feel different from usual headaches
• Patients with known connective tissue disorders (e.g. Marfan syndrome, polycystic kidney disease)

Cerebrovascular disease is often silent until it is not. Routine brain MRI or CT angiography can identify aneurysms early, when treatment is safest and most straightforward.

Partner Hospital Neurosurgery Department

The Neurosurgery team at a partner hospital in Xi'an has extensive experience in endovascular cerebrovascular procedures, including:

• Intracranial aneurysm coil embolisation
• Flow-diverter and mesh stent deployment
• Cerebral arteriovenous malformation (AVM) embolisation
• Carotid artery stenting

The department's approach combines modern imaging-guided technique with individualised risk assessment, aiming to achieve durable vascular protection with the least possible disruption to the patient's recovery.

Arranging a Brain Vascular Assessment in Xi'an

For international patients with a known aneurysm or a history of unexplained headaches, a neurovascular assessment at a specialist Chinese hospital offers access to expert endovascular teams and high-quality imaging at significantly lower cost than equivalent care in western countries. Contact a ChinaMedicalTour care navigator to arrange a consultation with English-language coordination.

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Clinical content provided by the Neurosurgery Department (Unit 1) of a partner hospital in Xi'an. Reviewed by Dr. Wang Bing, Neurosurgery Specialist. Published May 2026.

Frequently Asked Questions

Can overseas brain aneurysm patients submit CT angiography or MRI scans for specialist evaluation?

Yes. High-resolution DICOM imaging including 3D CT angiography, MR angiography, or digital subtraction angiography (DSA) can be reviewed by neurointerventional specialists through pre-consultation coordination to assess aneurysm morphology and procedure feasibility.

What endovascular techniques are evaluated for unruptured and complex aneurysms in China?

Leading neurovascular teams evaluate flow diverters (such as Tubridge and pipeline embolization devices), stent-assisted coiling, and balloon-assisted microcatheter coiling as minimally invasive alternatives to open craniotomy clipping.

How is post-procedure follow-up coordinated after endovascular treatment?

The treating neurointerventional team provides a detailed discharge plan outlining antiplatelet therapy regimens, follow-up imaging intervals, and complete bilingual medical records for domestic physicians.