Aneurysm coils five year Angiogram

Dear Ask The Doctor: Background: My 52 year old wife was diagnosed with a fairly small unruptured aneurysm 5 years ago. I forget the size but, her then doctor described it as a "borderline" candidate for coiling due it's size, but recommended the procedure. I believe 30 coils where used if memory serves me right. The doctor said the aneurysm was either 94% or 96% occluded after the procedure and that he considered this the same as 100% occluded. At the 1-year mark an angiogram was performed with no change. Each of following three years MRIs were done, with no change. Five year mark: and her doctor has since moved from Philadelphia to NJ and subsequently my wife's insurance company would not cover her visits her doctor of the past five years. Enter new doctor... He performed the 5-year mark angiogram yesterday. Due to a two week postponement of the appointment (on the doctors end) I was unable to accompany her. My wife gets very nervous and forgets to ask questions, (and her sister who went with her is the same) thus I'm left with the following limited information. Her new doctor says the coils that are there are pushed towards the back and that that "this is a good thing". Then he said he needs her last three MRI results to compare them with the size of the aneurysm today or as he said "To see how much it has grown". Then discuss it with her primary care doctor and decide from there. He also told her "You are in no imminent danger" Question 1. If he didn't study the last three MRIs, how does he know it's grown at all? Question 2. Shouldn't he have already studied the old MRIs before he even performed the angiogram? After all, my wife signed on the dotted line allowing them to add more coils if needed during the angiogram itself. Question 3. Wouldn't the doctor know if the aneurysm needed more coiling when doing angiogram regardless of whether it grew or not? Thank you very much for your time. Edward Ginger

Dear Edward: Your concerns are understandable and quite valid. I will answer each question individually.

1. Your wife's new doctor would like the old MRIs so that a comparison can be made. He does not know if any change has taken place and thus would like the previous images to make a comparison. He assumes that the aneurysm has grown somewhat since your wife has had it for quite some time but this is merely an assumption based on clinical experience and is not specific to your wife.

2. Regardless of the previous MRI results, your wife would still need new MRI to assess her current status. She will need yearly assessment with a MRI.

3. Her doctor can assess her MRI and determine if the aneurysm requires further coils if specific signs are present. If the aneurysms appears to be leaking, this would be an absolute indication for further stabilization using coils or some other means. However, another indication for further intervention is the amount of growth which has occurred in a year. Rapid growth is an indication that further treatment is required even though your wife may have no symptoms.

I hope your concerns have been satisfactorily addressed.