scholarly journals 3D rotational DSA: Diagnostic and therapeutic approach to cerebral aneurysms

2019 ◽  
Vol 1 (2) ◽  
pp. 3-7
Author(s):  
Karuna Tamrakar Karki ◽  
Duan Chuan Zhi ◽  
Li Tie Lin
Keyword(s):  
Digital Subtraction Angiography ◽  
Selection Criterion ◽  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Age Difference ◽  
Digital Subtraction ◽  
Parent Vessel ◽  
Treatment Protocols ◽  
Unruptured Aneurysms ◽  
Cranial Nerve Dysfunction

Background and purpose: Digital subtraction angiography (DSA), a minimally invasive procedure for an exceptional visualization of cerebrovascular angioarchitecture, has become an important imaging technique for inclusive evaluation and therapeutic embolization. Our purpose is to share the importance of DSA for evaluation of cerebral aneurysms. Material and method: A total of 148 patients with suspected intracranial aneurysm underwent digital subtraction angiography during January 2005 to December 2009. Preliminarily aortogram was considered in old age group (>50yrs) before supra-aortic angiography. Patient’s selection criterion included both ruptured and unruptured aneurysms. 3D rotational effect was applied for all complex cerebral aneurysms with unfavorable dome neck ratio. DSA was accomplished into 2- 6 standard projections for every vascular territory for optimal visualization and accurate evaluation of cerebral aneurysms. Result: 21 were males and 48 were females. Age difference was ranged between 26-78 years with an average of 51.5years. Among 288 patients, total detected aneurysms were 480. 32 presented with SAH, 21 presented with headache and 14 patients came with cranial nerve dysfunction during admission. 3 had negative angiography irrespective to spontaneous subarachnoid hemorrhage. Delineation of aneurysmal neck improved with rotation effect of 3D DSA in 80% of patients. Parent vessel and its relationship to adjacent vessels was better demonstrated with rotational angiography in >50% of cases. Endovascular embolization was done in 80 patients in same setting. Conclusion: DSA with 3D rotational technique is an essential radio-imaging tool for accurate characterization of cerebrovascular diseases and subsequently beneficial to elaborate on their potential treatment protocols.

Treatment and diagnosis of cerebral aneurysms in the post-International Subarachnoid Aneurysm Trial (ISAT) era: trends and outcomes

2020 ◽  
Vol 12 (7) ◽  
pp. 682-687 ◽  
Author(s):  
Evan Luther ◽  
David J McCarthy ◽  
Marie-Christine Brunet ◽  
Samir Sur ◽  
Stephanie H Chen ◽  
...  
Keyword(s):  
Treatment Modality ◽  
Cerebral Aneurysms ◽  
Mortality Rates ◽  
Endovascular Embolization ◽  
Primary Therapy ◽  
Surgical Clipping ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
International Subarachnoid Aneurysm Trial ◽  
Treatment Changes

BackgroundFollowing publication of the International Subarachnoid Aneurysm Trial (ISAT), treatment paradigms for cerebral aneurysms (CAs) shifted from open surgical clipping to endovascular embolization as primary therapy in a majority of cases. However, comprehensive analyses evaluating more recent CA diagnosis patterns, patient populations and outcomes as a function of treatment modality remain rare.MethodsThe National Inpatient Sample from 2004 to 2014 was reviewed. Aneurysmal subarachnoid hemorrhages (aSAHs) and unruptured intracranial aneurysms (UIAs) with a treatment of surgical clipping or endovascular therapy (EVT) were identified. Time trend series plots were created. Linear and logistic regressions were utilized to quantify treatment changes.Results114 137 aSAHs and 122 916 UIAs were reviewed. aSAH (+732/year, p=0.014) and UIA (+2550/year, p<0.0001) discharges increased annually. The annual caseload of surgical clippings for aSAH decreased (−264/year, p=0.0002) while EVT increased (+366/year, p=0.0003). For UIAs, the annual caseload for surgical clipping remained stable but increased for EVT (+615/year, p<0.0001). The rate of incidentally diagnosed UIAs increased annually (+1987/year; p<0.0001). Inpatient mortality decreased for clipping (p<0.0001) and EVT in aSAH (p<0.0001) (2004 vs 2014—clipping 13% vs 11.7%, EVT 15.8% vs 12.7%). Mortality rates for clipped UIAs decreased over time (p<0.0001) and remained stable for EVT (2004 vs 2014—clipping 1.57% vs 0.40%, EVT 0.59% vs 0.52%).ConclusionRuptured and unruptured CAs are increasingly being treated with EVT over clipping. Incidental unruptured aneurysm diagnoses are increasing dramatically. Mortality rates of ruptured aneurysms are improving regardless of treatment modality, whereas mortality in unruptured aneurysms is only improving for surgical clipping.

scholarly journals Discrepancy between two-dimensional and three-dimensional digital subtraction angiography for the planning of endovascular coiling of small cerebral aneurysms <5 mm

2020 ◽  
Vol 26 (6) ◽  
pp. 733-740
Author(s):  
Te-Chang Wu ◽  
Yu-Kun Tsui ◽  
Tai-Yuan Chen ◽  
Ching-Chung Ko ◽  
Chien-Jen Lin ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Three Dimensional ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Parent Artery ◽  
Two Dimensional ◽  
Digital Subtraction ◽  
Rotational Angiography ◽  
Treatment Choices ◽  
The Impact

Background To investigate the discrepancy between two-dimensional digital subtraction angiography and three-dimensional rotational angiography for small (<5 mm) cerebral aneurysms and the impact on decision making among neuro-interventional experts as evaluated by online questionnaire. Materials and methods Eight small (<5 mm) ruptured aneurysms were visually identified in 16 image sets in either two-dimensional or three-dimensional format for placement in a questionnaire for 11 invited neuro-interventionalists. For each set, two questions were posed: Question 1: “Which of the following is the preferred treatment choice: simple coiling, balloon remodeling or stent assisted coiling?”; Question 2: “Is it achievable to secure the aneurysm with pure simple coiling?” The discrepancies of angio-architecture parameters and treatment choices between two-dimensional-digital subtraction angiography and three-dimensional rotational angiography were evaluated. Results In all eight cases, the neck images via three-dimensional rotational angiography were larger than two-dimensional-digital subtraction angiography with a mean difference of 0.95 mm. All eight cases analyzed with three-dimensional rotational angiography, but only one case with two-dimensional-digital subtraction angiography were classified as wide-neck aneurysms with dome-to-neck ratio < 1.5. The treatment choices based on the two-dimensional or three-dimensional information were different in 56 of 88 (63.6%) paired answers. Simple coiling was the preferred choice in 66 (75%) and 26 (29.6%) answers based on two-dimensional and three-dimensional information, respectively. Three types of angio-architecture with a narrow gap between the aneurysm sidewall and parent artery were proposed as an explanation for neck overestimation with three-dimensional rotational angiography. Conclusions Aneurysm neck overestimation with three-dimensional rotational angiography predisposed neuro-interventionalists to more complex treatment techniques. Additional two-dimensional information is crucial for endovascular treatment planning for small cerebral aneurysms.

scholarly journals Multiple cerebral aneurysms as manifestations of cardiac myxoma: Brain imaging, digital subtraction angiography, and echocardiography

2011 ◽  
Vol 23 (2) ◽  
pp. 63-65 ◽  
Author(s):  
Kuo-Hsien Chiang ◽  
Hua-Ming Cheng ◽  
Bee-Song Chang ◽  
Cheng-Hui Chiu ◽  
Pao-Sheng Yen
Keyword(s):  
Brain Imaging ◽  
Digital Subtraction Angiography ◽  
Cardiac Myxoma ◽  
Cerebral Aneurysms ◽  
Digital Subtraction

Progressive thrombosis of unruptured aneurysms after coil embolization: analysis of 255 consecutive aneurysms

2019 ◽  
Vol 11 (11) ◽  
pp. 1113-1117 ◽  
Author(s):  
Yusuke Funakoshi ◽  
Hirotoshi Imamura ◽  
Shoichi Tani ◽  
Hidemitsu Adachi ◽  
Ryu Fukumitsu ◽  
...  
Keyword(s):  
Contrast Agent ◽  
Digital Subtraction Angiography ◽  
Coil Embolization ◽  
Endovascular Procedure ◽  
Digital Subtraction ◽  
Unruptured Aneurysms ◽  
Aneurysm Neck ◽  
Complete Obliteration ◽  
Neck Diameter

IntroductionWe have observed that aneurysms treated by insufficient coil embolization and filled with contrast agent immediately after the procedure are often completely occluded at follow-up. However, there are limited studies showing progressive thrombosis of aneurysms after coil embolization. Herein, we describe our experience with coil embolization for aneurysms, and discuss the factors involved in progressive thrombosis.MethodsA total of 255 aneurysms treated by coil embolization in our institute between January 2011 and June 2017 and observed >6 months were included. ‘Progressive thrombosis’ indicated that aneurysms that were neck remnant (NR) or dome filling (DF) immediately after coil embolization changed to complete obliteration (CO) at the 6-month follow-up digital subtraction angiography. The factors involved in progressive thrombosis were assessed.ResultsIn all aneurysms (n=255), 24 (9.4%) were CO, 82 (32.2%) were NR, and 149 (58.4%) were DF immediately after the procedure. At 6-month digital subtraction angiography, 123 (48.2%) were CO, 95 (37.3%) were NR, and 37 (14.5%) were DF. Retreatment for major recanalization was performed in eight cases (3.1%). One hundred and three aneurysms showed progressive thrombosis. There were significant differences in aneurysm location (P=0.0002), aneurysm dome diameter (P=0.0015), aneurysm neck diameter (P=0.0068), volume embolization ratio (P=0.0054), and endovascular procedure with stent (P=0.0264) between the progressive thrombosis and no thrombosis groups.ConclusionsProgressive thrombosis can occur in aneurysms after coil embolization depending on aneurysm location and size, and stent use. Thus, the degree of coil embolization and combination with a stent should be adjusted depending on aneurysm type.

Giant Cerebral Aneurysms: Comparing CTA, MRA, and Digital Subtraction Angiography Assessments

2020 ◽  
Vol 30 (3) ◽  
pp. 335-341
Author(s):  
Xiao Wang ◽  
John Benson ◽  
Bharathi Jagadeesan ◽  
Alexander McKinney
Keyword(s):  
Digital Subtraction Angiography ◽  
Cerebral Aneurysms ◽  
Digital Subtraction

Monorail Snare Technique for the Recovery of Stretched Platinum Coils: Technical Case Report

2005 ◽  
Vol 57 (suppl_1) ◽  
pp. E210-E210 ◽  
Author(s):  
David Fiorella ◽  
Felipe C. Albuquerque ◽  
Vivek R. Deshmukh ◽  
Cameron G. McDougall
Keyword(s):  
Cerebral Aneurysms ◽  
Distal Segment ◽  
Boston Scientific ◽  
Parent Vessel ◽  
Easy Method ◽  
Unruptured Aneurysms ◽  
Aneurysm Embolization ◽  
Platinum Coil ◽  
Significant Length ◽  
Neuroform Stent

Abstract OBJECTIVE AND IMPORTANCE: Coil stretching represents a potentially hazardous technical complication not infrequently encountered during the embolization of cerebral aneurysms. Often, the stretched coil cannot be advanced into the aneurysm or withdrawn intact. The operator is then forced to attempt to retract the damaged coil, which may result in coil breakage, leaving behind a significant length of potentially thrombogenic stretched coil material within the parent vessel. To overcome this problem, we devised a technique to snare the distal, unstretched, intact portion of the platinum coil by use of the indwelling microcatheter and stretched portion of the coil as a monorail guide. CLINICAL PRESENTATION: We have used this technique successfully in four patients to snare coils stretched during cerebral aneurysm embolization. Three of these patients were undergoing Neuroform (Boston Scientific/Target, Fremont, CA) stent-supported coil embolization of unruptured aneurysms. In all cases, the snare was advanced easily to the targeted site for coil engagement by use of the microcatheter as a monorail guide. Once the intact distal segment of the coil was ensnared, coil removal was uneventful, with no disturbance of the remainder of the indwelling coil pack or Neuroform stent. TECHNIQUE: A 2-mm Amplatz Goose Neck microsnare (Microvena Corp., White Bear Lake, MN) was placed through a Prowler-14 microcatheter (Cordis Corp., Miami, FL). The hub of the indwelling SL-10 microcatheter (Boston Scientific, Natick, MA) was then cut away with a scalpel, leaving the coil pusher wire intact, and removed. The open 2-mm snare was then advanced over the outside of the coil pusher wire and microcatheter. The snare and Prowler-14 microcatheter were then advanced into the guiding catheter (6- or 7-French) as a unit over the indwelling SL-10 microcatheter. By use of the SL-10 microcatheter and coil as a “monorail” guide, the snare was advanced over and beyond the microcatheter and the stretched portion of the coil until the snare was in position to engage the distal unstretched coil. At this point, the snare was then closed around the intact portion of the coil, and the microcatheters, snare, and coil were removed as a unit. CONCLUSION: The monorail snare technique represents a fast, safe, and easy method by which a stretched coil can be removed.

Optimized angiographic computed tomography with intravenous contrast injection: an alternative to conventional angiography in the follow-up of clipped aneurysms?

2012 ◽  
Vol 117 (1) ◽  
pp. 29-36 ◽  
Author(s):  
Philipp Gölitz ◽  
Tobias Struffert ◽  
Oliver Ganslandt ◽  
Marc Saake ◽  
Hannes Lücking ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Clinical Decision Making ◽  
Cerebral Aneurysms ◽  
Motion Artifacts ◽  
Digital Subtraction ◽  
Intravenous Contrast ◽  
Anterior Circulation ◽  
Conventional Angiography ◽  
True Negative

Object The purpose of this study was to evaluate the diagnostic accuracy of an optimized angiographic CT (ACT) program with intravenous contrast agent injection (ivACT) in the assessment of potential aneurysm remnants after neurosurgical clipping compared with conventional digital subtraction angiography (DSA). Methods The authors report on 14 patients with 19 surgically clipped cerebral aneurysms who were scheduled to undergo angiographic follow-up. For each patient, the authors performed ivACT with dual rotational acquisition and conventional angiography including a 3D rotational run. The ivACT and 3D DSA data were reconstructed with different imaging modes, including a newly implemented subtraction mode with motion correction. Thereafter, the data sets were merged by the dual-volume technique, and freely rotatable 3D images were obtained for further analysis. Observed aneurysm remnants were electronically measured and classified for each modality by 2 experienced neuroradiologists. Results Digital subtraction angiography and ivACT both provided high-quality images without motion artifacts. Artifact disturbances from the aneurysm clips led to a compromised, but still sufficient, image quality in 1 case. The ivACT assessed all aneurysm remnants as true-positive up to a minimal size of 2.6 × 2.4 mm in accordance with the DSA findings. There was a tendency for ivACT to overestimate the size of the aneurysm remnants. All cases without aneurysm remnants on DSA were scored correctly as true-negative by ivACT. Conclusions By using an optimized image acquisition protocol as well as enhanced postprocessing algorithms, the noninvasive ivACT seems to achieve results comparable to those of conventional angiography in the follow-up of clipped cerebral aneurysms. The authors have shown that ivACT can provide reliable diagnostic information about potential aneurysm remnants after neurosurgical clipping with high sensitivity and specificity, sufficient for clinical decision making, at least for aneurysms in the anterior circulation located distal to the internal carotid artery. These preliminary results may be a promising step to replace conventional angiography by a noninvasive imaging technique in selected cases after aneurysm clipping.

Comparison Between CTA and Digital Subtraction Angiography in the Diagnosis of Ruptured Aneurysms

Neurosurgery ◽  
2017 ◽  
Vol 80 (5) ◽  
pp. 769-777 ◽  
Author(s):  
Lucas R. Philipp ◽  
D. Jay McCracken ◽  
Courtney E. McCracken ◽  
Sameer H. Halani ◽  
Brendan P. Lovasik ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Small Sample ◽  
Digital Subtraction ◽  
Ruptured Intracranial Aneurysm ◽  
Small Sample Sizes ◽  
Low Sensitivity ◽  
Ruptured Intracranial Aneurysms

Abstract BACKGROUND: Computerized tomography angiography (CTA) is commonly used to diagnose ruptured cerebral aneurysms with sensitivities reported as high as 97% to 100%. Studies validating CTA accuracy in the setting of subarachnoid hemorrhage (SAH) are scarce and limited by small sample sizes. OBJECTIVE: To evaluate the diagnostic accuracy of CTA in detecting intracranial aneurysms in the setting of SAH. METHODS: A single-center, retrospective cohort of 643 patients was reviewed. A total of 401 patients were identified whose diagnostic workup included both CTA and confirmatory digital subtraction angiography (DSA). Aneurysms missed by CTA but diagnosed by DSA were further stratified by size and location. RESULTS: Three hundred and thirty aneurysms were detected by CTA while DSA detected a total of 431 aneurysms. False positive CTA results were seen for 24 aneurysms. DSA identified 125 aneurysms that were missed by CTA and 83.2% of those were &lt;5 mm in diameter. The sensitivity of CTA was 57.6% for aneurysms smaller than 5 mm in size, and 45% for aneurysms originating from the internal carotid artery. The overall sensitivity of CTA in the setting of SAH was 70.7%. CONCLUSION: The accuracy of CTA in the diagnosis of ruptured intracranial aneurysm may be lower than previously reported. CTA has a low sensitivity for aneurysms less than 5 mm in size, in locations adjacent to bony structures, and for those arising from small caliber parent vessels. It is our recommendation that CTA should be used with caution when used alone in the diagnosis of ruptured intracranial aneurysms.

scholarly journals Comparison of Efficacy of Intraoperative Indocyanine Green Videoangiography in Clipping of Anterior Circulation Aneurysms with Postoperative Digital Subtraction Angiography

2017 ◽  
Vol 08 (03) ◽  
pp. 342-345 ◽  
Author(s):  
Vikas Kumar ◽  
Anita Jagetia ◽  
Daljit Singh ◽  
Arvind Kumar Srivastava ◽  
Monica Sehgal Tandon
Keyword(s):  
Indocyanine Green ◽  
Digital Subtraction Angiography ◽  
Cerebral Aneurysms ◽  
Postoperative Outcome ◽  
Cost Effective ◽  
Digital Subtraction ◽  
Anterior Circulation ◽  
Indocyanine Green Videoangiography ◽  
Aneurysm Neck ◽  
Anterior Circulation Aneurysms

ABSTRACT Introduction: The aim of this study is to assess the efficacy of intraoperative indocyanine green videoangiography (ICG-VA) using postoperative digital subtraction angiography (DSA) in clipped anterior circulation aneurysms. Materials and Methods: A prospective study was conducted for 1 year which included thirty patients of anterior circulation aneurysm treated by clipping of aneurysm. Intraoperative ICG-VA was performed on all the patients. Postoperative DSA was performed to assess the efficacy of ICG-VA. Results: Intraoperative ICG-VA revealed the occlusion of aneurysm in all the thirty patients. Postoperative DSA revealed aneurysm neck remnant in two patients and demonstrated no branch occlusion. Conclusions: Intraoperative ICG-VA is useful in assessing the completeness of clipping of cerebral aneurysms and ensures patency of branch vessels, thus providing a better postoperative outcome. It replaces the need for invasive postoperative angiographic imaging in a selected group of patients and is also cost effective.

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