1. Intra-aneurysmal contrast agent stasis during intraoperative digital subtraction angiography may predict long-term occlusion after clipping.
- Author
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Grüter, Basil E., Catalano, Kristina, Anon, Javier, Gruber, Philipp, Thanabalasingam, Arjun, Andereggen, Lukas, Schubert, Gerrit A., Remonda, Luca, and Marbacher, Serge
- Subjects
DIGITAL subtraction angiography ,CONTRAST media ,INTRACRANIAL aneurysms ,ANGIOGRAPHY ,ENDOVASCULAR surgery - Abstract
Purpose: The routine use of intraoperative digital subtraction angiography (iDSA) increases detection of intracranial aneurysm (IA) remnants after microsurgical clipping. Spontaneous thrombosis of IA remnants after clipping is considered a rare phenomenon. We analyse iDSA characteristics to find predictors for IA remnant thrombosis. Methods: IA with intraoperative detection of a remnant after clipping were identified and divided into remnants experiencing spontaneous thrombosis, and remnants with long-term patency and/or remnant growth. Angiographic features of iDSA were analysed and compared between the two groups. Results: Of 37 IAs with intraoperative remnant on 3D-iDSA, five sustained a spontaneous remnant thrombosis and remained occluded in long-term follow-up. In all five cases, iDSA revealed delayed inflow and consequent stasis of the contrast agent until the late venous phase. On the other hand, in all cases with persistent long-term IA remnants (n = 32) iDSA demonstrated timely arterial contrast inflow and wash-out without stasis of intra-aneurysmal contrast agent. Conclusions: Contrast stasis in IA remnants during iDSA appears to predict long-term IA occlusion, indicating that clip correction manoeuvres or even attempted endovascular treatment of the remnant IA may be avoided in these patients. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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