Postoperative 3D angiography in intracranial aneurysms

BACKGROUND AND PURPOSE: Postsurgical evaluation of patients with intracranial aneurysms is important because there is a risk of regrowth and subarachnoid hemorrhage from residual aneurysms. We assessed the role and value of 3D angiography in this evaluation. METHODS: Images from both 3D angiography and digital subtraction angiography (DSA) were preoperatively obtained in 71 consecutive patients with 88 intracranial clipped aneurysms. We analyzed the incidence of postoperative residual aneurysms and compared the 3D angiographic and DSA images in these patients. RESULTS: With 3D angiography, 37 residual aneurysms were found among 88 clipped aneurysms. These comprised 12 large residual necks and 25 small, dog-eared remnants. DSA demonstrated 12 large, residual necks and only six small, dog-eared remnants. 3D angiography also demonstrated the clips, aneurysms, and parent arteries simultaneously, enabling us to appreciate the clip-aneurysm configuration completely. CONCLUSION: 3D angiography allowed us to detect more residual aneurysms after surgical clip placement than did conventional DSA, although none of those detected on only 3D angiography were judged to require additional treatment. 3D angiography may provide baseline data for the long-term follow-up of postsurgical aneurysms.