1. Value of 3-Dimensional Digital Subtraction Angiography for Detection and Classification of Intracranial Aneurysm Remnants After Clipping
- Author
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Serge Marbacher, Matthias Halter, Luca Remonda, Jenny C Kienzler, Javier Anon, Deborah R. Vogt, Stefan Wanderer, Michael Diepers, Javier Fandino, and Christian T. J. Magyar
- Subjects
Neuros/1 ,Patient demographics ,AcademicSubjects/MED00930 ,Hybrid operating room ,Aneurysm remnant ,Aneurysm ,Medical imaging ,Medicine ,postoperative ,Three-dimensional digital subtraction angiography ,Clipping (audio) ,Intraoperative ,medicine.diagnostic_test ,business.industry ,Clipping ,Odds ratio ,Gold standard (test) ,Digital subtraction angiography ,medicine.disease ,Intracranial aneurysm ,Surgery ,Neurology (clinical) ,Technique Assessment ,business ,Nuclear medicine - Abstract
BACKGROUND The current gold standard for evaluation of the surgical result after intracranial aneurysm (IA) clipping is two-dimensional (2D) digital subtraction angiography (DSA). While there is growing evidence that postoperative 3D-DSA is superior to 2D-DSA, there is a lack of data on intraoperative comparison. OBJECTIVE To compare the diagnostic yield of detection of IA remnants in intra- and postoperative 3D-DSA, categorize the remnants based on 3D-DSA findings, and examine associations between missed 2D-DSA remnants and IA characteristics. METHODS We evaluated 232 clipped IAs that were examined with intraoperative or postoperative 3D-DSA. Variables analyzed included patient demographics, IA and remnant distinguishing characteristics, and 2D- and 3D-DSA findings. Maximal IA remnant size detected by 3D-DSA was measured using a 3-point scale of 2-mm increments. RESULTS Although 3D-DSA detected all clipped IA remnants, 2D-DSA missed 30.4% (7 of 23) and 38.9% (14 of 36) clipped IA remnants in intraoperative and postoperative imaging, respectively (95% CI: 30 [ 12, 49] %; P-value .023 and 39 [23, 55] %; P-value =
- Published
- 2021