Diagnosing residual or recurrent cerebral aneurysms after clipping by computed tomographic angiography: Meta-analysis

Sun, Haogeng; Ma, Junpeng; Liu, Yi; Lan, Zhigang; You, Chao

doi:10.4103/0028-3886.107942

Cited by 10 publications

(5 citation statements)

References 18 publications

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“…CT angiography (CTA) is a convenient, noninvasive and reliable method for evaluation before treatment and after coiling or clipping treatment. 1,2 When metal coils or clips are placed in the cerebral artery, artefacts from metals may be produced, which usually influences the post-operative evaluation, especially the detection of residual aneurysm. Digital subtraction angiography is invasive and expensive even though it is the gold standard for diagnosis of the vascular diseases.…”

Section: Introductionmentioning

confidence: 99%

“…15 The application of CTA in cerebral aneurysms has been reported in several studies. 2,8 There are some reports on improving image quality and reducing artefacts by spectral CT. However, as far as we know, the effect of artefact reduction from metal coils or clips by using GSI in patients with cerebral aneurysms has not been described in detail.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Gemstone spectral imaging reduced artefacts from metal coils or clips after treatment of cerebral aneurysms: a retrospective study of 35 patients

Jia¹,

Zhang²,

Fan³

et al. 2015

BJR

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gemstone spectral imaging reduced artefacts from metal coils or clips after treatment of cerebral aneurysms: a retrospective study of 35 patients

Jia¹,

Zhang²,

Fan³

et al. 2015

BJR

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“…Multiple studies suggest that postoperative assessment of clipped aneurysms can be performed with CTA, as an alternative for DSA [7, 8, 12], or suggest to limit the use of DSA to certain indications [10, 17, 27]. However, a recent meta-analysis, with a total of 487 aneurysms, showed that CTA had a pooled sensitivity of only 71% and specificity of 94% for identifying residual or recurrent aneurysms in comparison to DSA [25]. For aneurysm residuals < 2 mm, the sensitivity has been shown to be even lower [26].…”

Section: Discussionmentioning

confidence: 99%

“…However, performing DSA routinely adds risk [29] and burden to a majority of patients whose aneurysms prove to be adequately obliterated. A less invasive alternative is computerized tomographic angiography (CTA), but this imaging technique has been shown to be less sensitive [25]. With the number of reoperations being small [5], no consensus currently exists regarding the implementation of routine postoperative imaging, either DSA or CTA.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the yield of post-clipping angiography and nationwide current practice

et al. 2019

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BackgroundSurgical treatment of intracranial saccular aneurysms aims to prevent (re)hemorrhage by complete occlusion of the aneurysmal lumen. It is unclear whether routine postoperative imaging, to assess aneurysmal occlusion, is necessary since intraoperative assessment by the neurosurgeon may be sufficient. We assessed routine clinical protocols for post-clipping imaging in the Netherlands and determined whether intraoperative assessment of aneurysm clippings sufficiently predicts aneurysm residuals.MethodsA survey was conducted to assess postoperative imaging protocols in centers performing clipping of intracranial aneurysms in the Netherlands (n = 9). Furthermore, a retrospective single-center cohort study was performed to determine the predictive value of intraoperative assessment of aneurysm occlusion in relation to postoperative digital subtraction angiography (DSA) findings, between 2009 and 2017.ResultsNo center performed intraoperative DSA in a hybrid OR, routinely. Respectively, four (44.4%), seven (77.8%), and three (33.3%) centers did not routinely perform early postoperative imaging, late follow-up imaging, or any routine imaging at all. Regarding our retrospective study, 106 patients with 132 clipped aneurysms were included. There were 23 residuals ≥ 1 mm (17.4%), of which 10 (43.5%) were unexpected. For the presence of these residuals, intraoperative assessment showed a sensitivity of 56.5%, a specificity of 86.2%, a positive predictive value of 46.4%, and a negative predictive value of 90.4%.ConclusionsThere is lack of consensus regarding the post-clipping imaging strategy in the Netherlands. Since intraoperative assessment is shown to be insufficient to predict postoperative aneurysm residuals, we advocate routine postoperative imaging after aneurysm clipping unless this is not warranted on the basis of patient age, clinical condition, and/or comorbidity.

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“…In a meta-analysis of 10 studies, the pooled sensitivity and specificity for detecting residual or recurrent aneurysms after clipping were 71% and 94%, respectively. 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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Diagnosing residual or recurrent cerebral aneurysms after clipping by computed tomographic angiography: Meta-analysis

Abstract: As a noninvasive and convenient screening method, CTA has a high diagnostic value for the detection of the residual or recurrent aneurysms after clipping. In the future, it may be used as a routine diagnostic tool for evaluation of aneurysms after clipping.

Cited by 10 publications

References 18 publications

Gemstone spectral imaging reduced artefacts from metal coils or clips after treatment of cerebral aneurysms: a retrospective study of 35 patients

Gemstone spectral imaging reduced artefacts from metal coils or clips after treatment of cerebral aneurysms: a retrospective study of 35 patients

Evaluation of the yield of post-clipping angiography and nationwide current practice

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

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