Comparison of multislice computed tomography angiography and digital subtraction angiography in the detection of residual or recurrent aneurysm after surgical clipping with titanium clips

Uysal, Ender; Özel, Alper; Ertürk, Şükrü Mehmet; Kirdar, Onder; Başak, Muzaffer

doi:10.1007/s00701-009-0184-x

Cited by 28 publications

(22 citation statements)

References 10 publications

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“…In general practice with adequate clipping, often no follow-up imaging is performed, or it may be limited to immediate perioperative angiography. 156 In ISAT, there was a slightly higher risk of recurrent hemorrhage from a coiled aneurysm than from those treated with surgical clipping, but the risks in both groups were very small.…”

Section: Analysis and Reportingmentioning

confidence: 93%

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Thompson¹,

Brown²,

Amin‐Hanjani³

et al. 2015

Stroke

799

352

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Purpose— The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. Methods— Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. Results— Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment.

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Section: Analysis and Reportingmentioning

confidence: 93%

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Thompson¹,

Brown²,

Amin‐Hanjani³

et al. 2015

Stroke

799

352

View full text Add to dashboard Cite

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“…CTA appears to be limited in detecting aneurysms less than 3 mm or when multiple clips were used [11]. Accuracy is also improved with the use of titanium clips and a multi-slice detector CTA [11][12].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Angiographic Findings in Patients Treated With Microsurgical Clipping of Intracranial Aneurysms

Harraher¹,

Steinberg²

2014

Cureus

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Microsurgical clipping remains a durable treatment for intracranial aneurysms. Despite the low rate of re-treatment, recurrence of subarachnoid hemorrhage is 3% within the first 10 years. This may be caused by rupture of a recurrent or residual aneurysm at the clip site or by rupture of another untreated aneurysm. We investigated the natural history of aneurysms treated with microsurgical clipping at our institution over a 10-year period. A secondary objective was to analyze our compliance rate with follow-up angiograms at three and 10 years and to investigate a role for less-invasive imaging modalities to manage microsurgical clipping patients. Ruptured and/or unruptured aneurysm patients treated with microsurgical clipping from 2000-2008 who had angiographic follow-up were included. Data were analyzed with respect to formation of de novo aneurysms, presence of residual aneurysm after clipping, and the rate of recurrence after complete clipping. There were 24 residual aneurysms (13%), two de novo aneurysms (1%) and one recurrent aneurysm (0.5%). The size of the aneurysm was significantly associated with having a residual aneurysm. Patient sex was also significantly associated with having a residual aneurysm. Compliance with angiographic follow-up occurred in 31% of patients treated with the majority only having one study at three years. Microsurgical clipping of aneurysms is durable with a low rate of recurrence and rebleeding. Residuals do not show angiographic progression and rarely require re-treatment. Compliance with angiographic follow-up is poor and this suggests that less invasive and expensive imaging modalities should be evaluated.

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“…The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for CT angiography was achieved as 99, 99, 90, 96, and 98 by Westerlaan et al (17). Uysal et al reported the sensitivity and specificity of CT angiography in detecting aneurysm as 98.6 and 97.6, respectively (9).…”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Value of CT Angiography in the Diagnosis of Residual Aneurysm After Brain Aneurysm Surgery

et al. 2018

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Background: The existence of residual aneurysm after intracranial aneurysm clipping bears the risk of re-bleeding, which worsens with the passage of time. Digital subtraction angiography (DSA) is accepted as the gold standard for evaluation of residual aneurysm, but it is invasive, costly, and serious complications are possible. Objectives: The aim of this study was to compare DSA to 64-slice CT angiography for assessing residual aneurysm. Patients and Methods: Forty patients with 43 clipped aneurysms from which 36 were torn, were evaluated by DSA after improvement in clinical status, and after a month they were evaluated by 64-slice CT angiography. The pictures were assessed by two neuroradiologists separately, in terms of quality, artifact due to the clips, and the completion of aneurysm closing. Results: In multislice computed tomographic angiography (MSCT) analysis, 36 pictures (90%) had good quality and four pictures (10%) had poor quality. In case of good quality pictures in MSCT and angiography, the 2-and 3-millimeter residual aneurysms were approved for two patients based on which, sensitivity, feature and positive/negative predictive value for diagnosis of residual aneurysm was 100 for good-quality pictures by MSCT. The level of agreement between the two neuroradiologists was 1 for diagnosing residual aneurysm and 0.86 for vasospasm. The average time for doing MSCT was 12 minutes compared to 45 minutes for DSA angiography, which was cost effective. Conclusion: CT angiography is a less invasive method with high sensitivity and capabilities for diagnosing residual aneurysm. It is cheaper, quicker and can be accomplished for critical patients. Therefore, it can be taken as the first choice and a replacement for DSA in post-surgery evaluation of patients with clipped brain aneurysm.

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Comparison of multislice computed tomography angiography and digital subtraction angiography in the detection of residual or recurrent aneurysm after surgical clipping with titanium clips

Abstract: Using MDCTA, it is possible to demonstrate the status of intracranial aneurysms after surgical clipping in the immediate postoperative period as well as long-term follow-up with an high sensitivity and specificity when comparing with the findings of DSA.

Cited by 28 publications

References 10 publications

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Long-Term Angiographic Findings in Patients Treated With Microsurgical Clipping of Intracranial Aneurysms

The Diagnostic Value of CT Angiography in the Diagnosis of Residual Aneurysm After Brain Aneurysm Surgery

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