Comparison of routine and selective use of intraoperative angiography during aneurysm surgery: a prospective assessment

Abstract

Given the frequency of significant disease that remains undetected if intraoperative angiography is used on a selective basis and the low complication rate associated with the procedure, the use of intraoperative angiography should be considered in the majority of aneurysm cases.

Feasibility of Flat Panel Angiographic CT after Intravenous Contrast Agent Application in the Postoperative Evaluation of Patients with Clipped Aneurysms

“…29,30 Several research articles supported the fact that incomplete occlusion of operated aneurysms or other major findings, such as parent artery stenosis or occlusion, can be, even unexpectedly, detected on routine postoperative angiography, thus emphasizing the importance of intra-or postoperative imaging after surgical clipping. [1][2][3][4][5] Nevertheless, current clinical convention holds that intra-or postoperative angiography be used on a selective basis for complex aneurysms when the surgeon is not confident of the outcome of the operation, though prospective studies have documented that even experienced surgeons cannot accurately predict the necessity of Fig 2. A, In another example, a middle cerebral artery bifurcation aneurysm was treated with 2 normal-sized clips. B, Coronal IV-ACT maximum intensity projection of the clipped aneurysm with a section thickness of 1 mm delineates a very small aneurysm remnant (black arrow) with a diameter of 1.5 mm.…”

“…4 The most likely reason for this discrepancy, besides its invasive nature, has to lie in the timeconsuming and resource-intensive character of IA-DSA.…”

“…There are several studies suggesting that important findings such as major arterial occlusion or narrowing as well as residual aneurysm can be detected on routine postoperative angiography, often even to the surprise of the operating surgeon, therefore emphasizing the importance of intra-or postoperative vessel delineation after clipping of intracranial aneurysms. [1][2][3][4][5] In various studies, the percentage of neck remnants ranges from 4% to 18%. 5,6 Long-term follow-up data of clipped aneurysms also suggest that there is a risk of de novo appearance of new aneurysms and regrowth of previously treated aneurysms.…”

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

“…The use of intraoperative angiography to verify complete aneurysm obliteration at the time of surgery and verify the patency of branch vessels has become more widespread, especially at tertiary centers. [237][238][239][240][241] Case series have demonstrated unexpected findings (such as vessel occlusions or residual aneurysms) in ≈7% to 12% of cases, 237,239,242 leading to alterations in clipping and thus providing an indirect validation of its value. Because of the time, expertise, and expense associated with intraoperative angiography, other tools have also emerged that can provide more immediate feedback related particularly to vessel compromise.…”

Intraoperative Near-infrared Indocyanine Green Videoangiography Performed with a Surgical Microscope - Applications in Cerebrovascular Surgery

“…[12][13][14][15][16][17][18][19] Furthermore, several reports indicated that intraprocedural changes significantly affected the surgical procedure in 7-34% of cases. [12][13][14][15][16][17][18][19] They also showed that the findings identified on ICG videoangiography were consistent with those on post-operative digital substraction angiograms. 5,6 The ICG technique provided information relevant to the surgical procedure in 9% of cases, including vessel occlusion or stenosis and residual filling of aneurysms.…”