Angiography after Aneurysm Surgery: Indications for “Selective” Angiography

Rauzzino, Michael J.; Quinn, Mark; Fisher, Wink S.

doi:10.1016/s0090-3019(97)00035-9

Cited by 74 publications

(41 citation statements)

References 21 publications

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“…Except for the results of postoperative cerebral angiography, these were relatively high rates compared with previous incidences, 5,8,18,24) and may be attributed to various factors. First, in the present study, a small residual neck that may have been previously ignored was included as an aneurysm remnant.…”

Section: Discussionmentioning

confidence: 58%

“…20) Many cases of regrowth and rerupture have been reported after clipping of ICA-PCoA aneurysms, 4,11,16,19,21) although the incidence of aneurysm remnants at this location differs. 14,16,18,20) Third, the present study included a thorough search for aneurysm remnants using endoscopy during surgery, especially around the blind corner between the aneurysm and its parent artery. Fourth, half of the aneurysms were unruptured.…”

Section: Discussionmentioning

confidence: 99%

“…24) Aneurysm remnants after clipping may regrow and lead to recurrent symptoms of hemorrhage or mass effect. 4,5,[7][8][9]11,14,[16][17][18][19][20][21]24) Therefore, aneurysm surgery should aim at complete circulatory exclusion of aneurysms, but this cannot be achieved in several circumstances including large necks, insufficient exposure, and mal-positioning of clips. 4,7,9,20) Aneurysm remnants can be classified into two groups, dog-ear and broad-based remnant.…”

Section: Introductionmentioning

confidence: 99%

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Simulation of Clipping Position for Cerebral Aneurysms Using Three-dimensional Computed Tomography Angiography

Futami

Nakada

Iwato

et al. 2004

Neurol. Med. Chir.(Tokyo)

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A novel method for the simulation of the clipping position for cerebral aneurysms based on threedimensional computed tomography (3D CT) angiography was evaluated. Rotating the regional 3D CT angiography images including the aneurysm provided the virtual intraoperative views of 36 cerebral aneurysms that were eligible for clipping through a pterional approach with a perpendicularly applied straight clip. The cut-along-trace function of the 3D CT workstation was used to simulate the clipping position. The presence or absence of aneurysm remnants was preoperatively evaluated by observing the clipping simulation image. Intraoperative endoscopy and postoperative cerebral angiography were routinely performed to confirm the completeness of obliterations. Nineteen of 21 aneurysms for which complete obliteration was preoperatively expected were confirmed to have no aneurysm remnant. Nine of 15 aneurysms which were expected to have aneurysm remnant were confirmed to persist. The clipping simulation images could correctly predict aneurysm remnant after the initial clipping with a sensitivity of 90.5% and specificity of 60%. The present simulation method can predict aneurysm remnants and improve the likelihood of complete obliteration by clipping.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Simulation of Clipping Position for Cerebral Aneurysms Using Three-dimensional Computed Tomography Angiography

Futami

Nakada

Iwato

et al. 2004

Neurol. Med. Chir.(Tokyo)

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“…3,11 Factors like the size and shape of the reperfused aneurysm, the relation of the open aneurysm part to the parent vessel, and the challenge of predicting the risk of rebleeding have been widely discussed in the literature. 8,11,13,14 Currently, the standard method in the assessment of the occlusion rate of a clipped aneurysm is a subjective occlusion rating based on postoperative early or late angiography. However, recently we showed that for ruptured coil-embolized cerebral aneurysms, the computerized occlusion rating is superior to the SOR by reducing subjective bias in estimating occlusion rates and by avoiding interobserver variability.…”

Section: Discussionmentioning

confidence: 99%

Computerized Angiographic Occlusion Rating for Ruptured Clipped Aneurysms is Superior to Subjective Occlusion Rating

Al-Schameri¹,

Baltsavias

Winkler³

et al. 2015

AJNR Am J Neuroradiol

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“…[1][2][3]6,7,9,11,16,17,19,21,22,28,32) Clip adjustment was performed in 13.8% of cases: residual aneurysms and arterial (Table 4). 5,8,14,15,17,23,25,27,31) The size and location of the aneurysm are correlated with the need to reposition the aneurysm clip after intraoperative angiography. 1,7,22) The subgroup of patients with giant or large aneurysm, and basilar apex, posterior communicating artery, or superior hypophyseal artery aneurysms had a significantly higher incidence of clip adjustment.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Angiography Evaluation of the Microsurgical Clipping of Unruptured Cerebral Aneurysms.

Yanaka

Asakawa

Noguchi

et al. 2002

Neurol. Med. Chir.(Tokyo)

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Intraoperative angiography evaluation of the clippings of cerebral aneurysms was investigated in a series of 38 consecutive patients with unruptured cerebral aneurysms to determine any favorable impact on the outcome. Unexpected findings including major arterial occlusion or residual aneurysm were identified. Specific variables such as the size and site of aneurysm were analyzed to determine the impact on clinical outcome and the incidence of clip modification. There were 11 large and 27 small aneurysms in this series. Mortality and permanent morbidity after microsurgical clipping were 0.0% and 2.6%, respectively. Unexpected angiographic findings necessitating clip repositioning consisted of residual aneurysm in two cases and distal branch occlusion or parent vessel stenosis in four. The need for clip modification was significantly higher for large than for small aneurysms (p ＝ 0.007), and the rate of clip adjustment increased with increasing aneurysm size (p ＝ 0.008). Intraoperative assessment prior to wound closure allows for the recognition and correction of defects and decreases the risk of postoperative complications. Intraoperative angiography may become important in the microsurgical clipping of unruptured cerebral aneurysms, especially large aneurysms.

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Angiography after Aneurysm Surgery: Indications for “Selective” Angiography

Cited by 74 publications

References 21 publications

Simulation of Clipping Position for Cerebral Aneurysms Using Three-dimensional Computed Tomography Angiography

Simulation of Clipping Position for Cerebral Aneurysms Using Three-dimensional Computed Tomography Angiography

Computerized Angiographic Occlusion Rating for Ruptured Clipped Aneurysms is Superior to Subjective Occlusion Rating

Intraoperative Angiography Evaluation of the Microsurgical Clipping of Unruptured Cerebral Aneurysms.

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