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DOI: 10.1055/s-0030-1261946
© Georg Thieme Verlag KG Stuttgart · New York
IvACT after Aneurysm Clipping as an Alternative to Digital Subtraction Angiography – First Experiences
Publikationsverlauf
Publikationsdatum:
19. August 2010 (online)
![](https://www.thieme-connect.de/media/zblneurochir/201003/lookinside/thumbnails/10.1055-s-0030-1261946-1.jpg)
Abstract
Objective: After clipping of intracranial aneurysms, digital subtraction angiography (DSA) is recommended for the proof of complete aneurysm occlusion or identification of aneurysm remnants, especially in cases with a more complex angioarchitecture or a difficult operative course. The aim of this study was to evaluate if postoperative intravenous angiographic computed tomography (ivACT) could be a diagnostic alternative in cases of contraindications for DSA.
Material and Methods: 13 patients (12 female, 1 male) underwent surgical clipping of 5 ruptured and 10 innocent aneurysms. Postoperative ivACT was performed in all patients due to refusal or contraindications for DSA.
Results: 12 patients had almost complete aneurysm clipping, while 1 patient's was incomplete, which was diagnosed by ivACT and confirmed by subsequent postoperative digital subtraction angiography (DSA), which had been accepted by the patient after clarification of the postoperative findings.
Conclusion: This study illustrates the efficacy of ivACT for postoperative control of surgically treated aneurysms. The quality of ivACT generated images seems to be sufficient in the detection of residual aneurysms after clipping. In cases with inconclusive results, postoperative DSA should be performed to obtain further details.
Key words
ivACT - flat panel detector - aneurysm - clipping - subarachnoid hemorrhage
References
- 1 Agid R, Lee SK, Wilinsky RA. et al . Acute subarachnoid hemorrhage: using 64-slice multidetector CT angiography to “triage” patients’ treatment. Neuroradiology. 2006; 48 787-794
- 2 Akyüz M, Tuncer R, Yilmaz S. et al . Angiographic follow-up after surgical treatment of intracranial aneurysms. Acta Neurochir (Wien). 2004; 146 245-250
- 3 Benndorf G, Claus B, Strother CM. et al . Increased cell opening and prolapse of struts of a neuroform stent in curved vasculature: value of angiographic computed tomography: technical case report. Neurosurgery. 2006; 58 (ONS Suppl. 2) ONS-380-ONS-381
- 4 Biasi L, Ali T, Hinchliffe R. et al . Intraoperative DynaCT detection and immediate correction of a type 1a endoleak following endovascular repair of abdominal aortic aneurysm. Cardiovasc Intervent Radiol. 2009; 32 535-538
- 5 Biasi L, Ali T, Thompson M. Intra-operative DynaCT in visceral-hybrid repair of an extensive thoracoabdominal aortic aneurysm. Eur J Cardiothorac Surg. 2008; 34 (6) 1251-1252
- 6 Buhk JH, Elolf E, Jacob D. et al . A comparison of angiographic CT and multisection CT in lumbar myelographic imaging. AJNR. 2008; 29 (3) 442-446
- 7 Buhk JH, Elolf E, Knauth M. Angiographic computed tomography is comparable to multislice computed tomography in lumbar myelographic imaging. J Comput Assist Tomogr. 2006; 30 (5) 739-741
- 8 Buhk JH, Kallenberg K, Mohr A. et al . Evaluation of angiographic computed tomography in the follow-up after endovascular treatment of cerebral aneurysms – a comparative study with DSA and TOF-MRA. Eur Radiol. 2009; 19 (2) 430-436
- 9 Chen W, Yang Y, Qiu J. et al . 16-row multislice computerized tomography angiography in the postoperative evaluation of patients with intracranial aneurysms. Br J Neurosurg. 2008; 22 (1) 63-70
- 10 Cloft HJ, Joseph GJ, Dion JE. Risk of cerebral angiography in patients with subarachnoid haemorrhage, cerebral aneurysm, and arterio-venous malformation: a meta-analysis. Stroke. 1999; 30 317-320
- 11 Dörfler A, Struffert T, Engelhorn T. et al . Rotational flat-panel computed tomography in diagnostic and interventional neuroradiology. Rofo. 2008; 180 (10) 891-898
- 12 Dorsch NWC, Young N, Kingston RJ. et al . Early experience with spiral CT in the diagnosis of intracranial aneurysms. Neurosurgery. 1995; 36 230-238
- 13 Drake CG, Allcock JM. Postoperative angiography and the “slipped” clip. J Neurosurg. 1973; 39 683-689
- 14 Eide KR, Odegard A, Myhre HO. et al . Initial observations of endovascular aneurysm repair using Dyna-CT. J Endovasc Ther. 2007; 14 (1) 50-53
- 15 Eide KR, Odegard M, Myhre HO. et al . DynaCT during EVAR – a comparison with multidetector CT. Eur J Vasc Endovasc Surg. 2009; 37 (1) 23-30
- 16 Ernemann UU, Gronewaller E, Duffner FB. et al . Influence of geometric and hemodynamic parameters on aneurysm visualization during 3-dimensional rotational angiography: an in vitro study. AJNR. 2003; 24 597-603
- 17 Feuerberg I, Lindquist C. Natural history of postoperative aneurysm rests. J Neurosurg. 1987; 66 30-34
- 18 Gönner F, Lövblad KO, Heid O. et al . Magnetic resonance angiography with ultrashort echo times reduces the artefact of aneurysm clips. Neuroradiology. 2002; 44 755-758
- 19 Gonzalez-Darder JM, Pesudo-Martinez JV. et al . Microsurgical management of cerebral aneurysms based in CT angiography with 3-dimensional reconstruction (3D-CTA) and without preoperative cerebral angiography. Acta Neurochir (Wien). 2001; 143 673-679
- 20 Grieve JP, Stacey R, Moore E. et al . Artefact on MRA following aneurysm clipping: an in vitro study and prospective comparison with conventional angiography. Neuroradiology. 1999; 41 680-686
- 21 Grzyska U, Freitag J, Zeumer H. “Selective cerebral intraarterial” DSA. Complication rate and control of risk factors. Neuroradiology. 1990; 32 296-299
- 22 Heran NS, Song JK, Namba K. et al . The utility of DynaCT in neuroendovascular procedures. AJNR. 2006; 27 330-332
- 23 Hiu T, Kitagawa N, Morikawa M. et al . Efficacy of DynaCT digital angiography in the detection of the fistulous point of dural arteriovenous fistulas. AJNR. 2009; 30 (3) 487-491
- 24 Hoh BL, Cheung AC, Rabinov JD. et al . Results of a prospective protocol of computed tomographic angiography in place of catheter angiography as the only diagnostic and pretreatment planning study for cerebral aneurysms by a combined neurovascular team. Neurosurgery. 2004; 54 (6) 1329-1342
- 25 Irie K, Murayama Y, Saguchi T. et al . DynaCT soft-tissue visualization using an angiographic C-arm system: Initial clinical experience in the operating room. Neurosurgery. 2008; 62 (Suppl. 1) ONS-266-ONS-272
- 26 Jou LD, Mohamed A, Lee DH. et al . 3D rotational digital subtraction angiography may underestimate intracranial aneurysms: findings from 2 basilar aneurysms. AJNR. 2007; 28 1690-1692
- 27 Kassel N. Angiography after aneurysm surgery. J Neurosurg. 1994; 80 953
- 28 Kato Y, Katada K, Hayakawa M. et al . Can 3D-CTA surpass DSA in diagnosis of cerebral aneurysm?. Acta Neurochir (Wien). 2001; 143 245-250
- 29 Kato Y, Sano H, Katada K. et al . Effects of new titanium cerebral aneurysm clips on MRI and CT images. Minim Invas Neurosurg. 1996; 39 82-85
- 30 Kivisaari RP, Porras M, Öhman J. et al . Routine cerebral angiography after surgery for saccular aneurysms: is it worth it?. Neurosurgery. 2004; 55 (5) 1015-1024
- 31 Lee JH, Kim SJ, Cha J. et al . Postoperative multidetector computed tomography angiography after aneurysm clipping. Comput Assist Tomogr. 2005; 29 (1) 20-25
- 32 LeRoux PD, Elliott JP, Eskridge JM. et al . Risks and benefits of diagnostic angiography after aneurysm surgery. Analysis of 597 studies. Neurosurgery. 1998; 42 1248-1255
- 33 Lin T, Fox AJ, Drake DG. Regrowth of aneurysm sacs from residual neck following aneurysm surgery. J Neurosurg. 1989; 70 1153-1159
- 34 MacDonald RL, Wallace MC, Kestle JRW. Role of angiography following aneurysm surgery. J Neurosurg. 1993; 79 826-832
- 35 Murphy M, Bell D, Worth RD. et al . Angiography postclipping and coiling of cerebral aneurysms. Br J Neurosurg. 2005; 19 (3) 225-228
- 36 Nijjar S, Patel B, McGinn G. et al . Computed tomographic angiography as the primary diagnostic study in spontaneous subarachnoid hemorrhage. J Neuroimaging. 2007; 17 295-299
- 37 Nölker G, Gutleben KJ, Marschang H. et al . 3-dimensional left atrial and esophagus reconstruction using cardiac C-arm computed tomography with image integration into fluoroscopic views for ablation of atrial fibrillation: accuracy of a novel modality in comparison with multislice computed tomography. Heart Rhythm. 2008; 5 (12) 1651-1657
- 38 Orth RC, Wallace MJ, Kuo MD. C-arm cone-beam CT: general principles and technical considerations for use in interventional radiology. J Vasc Interv Radiol. 2008; 19 814-820
- 39 Pechlivanis I, Koenen D, Engelhardt M. et al . Computed tomographic angiography in the evaluation of clip placement for intracranial aneurysm. Acta Neurochir (Wien). 2008; 150 669-676
- 40 Pechlivanis I, Koenig M, Engelhardt M. et al . Evaluation of clip artefacts in 3-dimensional computed tomography. Cen Eur Neurosurg. 2009; 70 (1) 9-14
- 41 Psychogios MN, Buhk JH, Schramm P. et al . Feasibility of angiographic computed tomography in the periinterventional diagnostic imaging – a comparative study with multidetector computed tomography. AJNR. 2010; accepted for publication
- 42 Raabe A, Beck J, Gerlach R. et al . Near-infrared indocyanine green video angiography: a new method for intraoperative assessment of vascular flow. Neurosurgery. 2003; 52 (1) 132-139
- 43 Raabe A, Nakaji P, Beck J. et al . Prospective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery. J Neurosurg. 2005; 103 (6) 982-989
- 44 Rohde V, Hans FJ, Mayfrank L. et al . How useful is the 3-dimensional, surgeon's perspective-adjusted visualisation of the vessel anatomy during aneurysm surgery. A prospective clinical trial. Neurosurg Rev. 2007; 30 (3) 209-216
- 45 Sakuma I, Tomura N, Kinouchi H. et al . Title: Postoperative 3-dimensional CT angiography after cerebral aneurysm clipping with titanium clips: detection with single detector CT? Comparison with intra-arterial digital subtraction angiography. Clin Radiol. 2006; 61 (6) 505-512
- 46 Sindou M, Acevedo JC, Turjman F. Aneurysmal remnants after microsurgical clipping: classification and results from a prospective angiographic study in a consecutive series of 305 operated intracranial aneurysms. Acta Neurochir (Wien). 1998; 140 1153-1159
- 47 Teksam M, McKinney A, Cakir B. et al . Multi-slice computed tomography angiography in the detection of residual or recurrent cerebral aneurysms after surgical clipping. Acta Radiol. 2004; 5 571-576
- 48 Uysal E, Ozel A, Erturk SM. et al . Comparison of multislice computed tomography angiography and digital substraction angiography in the detection of residual or recurrent aneurysm after surgical clipping with titanium clips. Acta Neurochir (Wien). 2009; 151 131-135
- 49 Valdivia Y, Alvarado M, Ebrahimi BS. et al . Study of conformability of the lew LEO PLUS stent to a curved vascular model using flat-panel detector computed tomography (DynaCT). Neurosurgery. 2009; 64 (ONS Suppl. 1) ONS-130-ONS-134
- 50 van Loon JJ, Yousry TA, Fink U. et al . Postoperative spiral computed tomography and magnetic resonance angiography after aneurysm clipping with titanium clips. Neurosurgery. 1997; 41 (4) 851-856
- 51 Wallace RC, Karis JP, Partovi S. et al . Noninvasive imaging of treated cerebral aneurysms, part II: CT angiographic follow-up of surgically clipped aneurysms. AJNR. 2007; 28 1207-1212
- 52 Watanabe Y, Kashiwagi N, Yamada N. et al . Subtraction 3D CT angiography with the orbital synchronized helical scan technique for the evaluation of postoperative cerebral aneurysms treated with cobalt-alloy clips. AJNR. 2008; 29 1071-1075
- 53 Westerlaan HE, Gravendeel J, Fiore D. et al . Multislice CT angiography in the selection of patients with ruptured intracranial aneurysms suitable for clipping or coiling. Neuroradiology. 2007; 49 997-1007
- 54 Willinsky RA, Taylor SM, TerBrugge K. et al . Neurologic complications of cerebral angiography: prospective analysis of 2899 procedures and review of the literature. Radiology. 2003; 227 522-528
1 both authors contributed equally to this work
Correspondence
Dr. D. Wachter
Georg-August-Universität
Göttingen
Neurochirurgie
Robert-Koch-Straße 40
37075 Göttingen
Germany
Telefon: +49/551/39 6948
Fax: +49/551/39 8796
eMail: dorothee.wachter@gmx.de