The Interventional Procedures Advisory Committee (IPAC) originally considered this procedure as part of coil embolisation for intracranial aneurysms. However, as a result of comments received during the initial consultation in June 2003, IPAC decided to consider the procedure separately for ruptured intracranial aneurysms and for unruptured intracranial aneurysms.
The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on coil embolisation of unruptured intracranial aneurysms.
As part of the NICE's work programme, the current guidance was considered for review but did not meet the review criteria as set out in the IP process guide. The guidance below therefore remains current.
To be alerted to developments regarding the use of the procedure to treat ruptured intracranial aneurysms please refer to IPG106.
Intracranial aneurysms are dilated blood vessels within the skull. Usually, the cause is unknown but people with genetic causes of weak blood vessels are more likely to develop aneurysms.
Rupture of intracranial aneurysms causes subarachnoid haemorrhage and has a poor prognosis. About 30% of people die within 24 hours and a further 25-30% die within 4 weeks.
The traditional treatment for ruptured or unruptured aneurysms involves open surgery to clip the abnormal blood vessels inside the skull.
The coil technique involves approaching the aneurysm from inside the diseased blood vessel, avoiding the need to open the skull. The coil technique is therefore an endovascular technique. A thin tube containing the coil on a guidewire is inserted into a large artery, usually in the groin, and passed up into the skull under radiological guidance. The coil is placed inside the aneurysm and detached from the guidewire. Multiple coils may be placed into the aneurysm through the same tube until the aneurysm is densely packed.
The coil technique is mainly carried out on ruptured aneurysms but may also be used to treat unruptured aneurysms.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.