[Endovascular therapy for intracranial aneurysms]

3D rotational angiography for the diagnosis and preoperative assessment of intracranial aneurysms: preliminary experience

PURPOSE

The aim of this study was to assess the value of the systematic use of 3D rotational angiography (3DRA) in the diagnosis and preoperative evaluation of cerebral aneurysms with a view to planning endovascular embolisation.

MATERIALS AND METHODS

Thirty-five consecutive aneurysms (20 incidental and 15 after subarachnoid haemorrhage) were studied and treated by means of 3DRA over a 1-year period. All rotational studies were conducted by selective cannulation of the vessel supplying the lesion (internal carotid artery or vertebral artery) with a single injection of 20 cc of contrast agent after diagnostic angiography in anterior-posterior (AP) and laterolateral (LL) views. Three-dimensional reconstructions were generated within a mean time of 5 min, and coil embolisation was performed on the basis of the 3D images.

RESULTS

Three-dimensional RA enabled accurate definition of site, orientation, morphology and size of the sac and its relationship with the parent arteries and helped us choose the most appropriate angulation of the C-arm for guiding and controlling the embolisation procedure. Furthermore, the technique allowed us to detect six aneurysms for which conventional imaging had yielded equivocal results.

CONCLUSIONS

Based on our experience before RA equipment became available and in agreement with the literature, we believe that 3DRA improves the identification of all lesions and helps refine the choice of the most suitable embolisation material and technique. Three-dimensional RA requires substantially fewer projections and thus reduces radiation dose and volume of contrast material to the patient. The use of 3DRA most likely results in a shorter procedure time and fewer risks and complications for the patient.