gms | German Medical Science

Objective: After clipping of intracranial aneurysms, aneurysm remnants and inadvertent vessel occlusion are seen on digital subtraction angiography (DSA) in up to 10% of the cases, raising the question if routine postoperative angiographic control should be recommended. On the other hand, DSA carries a certain risk of stroke, leading to the search for less invasive diagnostic tools such as CT angiography. Very recently, intravenous angiographic computed tomography (ivACT) was introduced which has the advantage of reduced radiation dosage and the ability to generate multiplanar images. It is the aim of the study to investigate if ivACT has the potential to replace DSA after aneurysm clipping.

Methods: Twenty patients (14 female, 6 male) underwent surgical clipping of 14 ruptured and nine innocent aneurysms. Two patients presented with multiple aneurysms. Postoperative ivACT as well as DSA was performed in all patients.

Results: Seventeen patients had complete aneurysm clipping proved in both DSA and ivACT. In two patients small neck remnants of 1.5 and 3 mm without need for further therapy were diagnosed by ivACT and confirmed by subsequent postoperative DSA. In one patient with a large innocent infraclinoidal ICA aneurysm, a broad based neck remnant was seen on ivACT and DSA.

Conclusions: This study illustrates the efficacy of ivACT digital angiography for postoperative control of surgically treated aneurysms. The quality of ivACT generated images seams to be sufficient in the detection of residual aneurysms after clipping. In case of insecure results, postoperative DSA should be performed to obtain further details.