{Reference Type}: Journal Article
{Title}: Intra-aneurysmal contrast agent stasis during intraoperative digital subtraction angiography may predict long-term occlusion after clipping.
{Author}: Grüter BE;Catalano K;Anon J;Gruber P;Thanabalasingam A;Andereggen L;Schubert GA;Remonda L;Marbacher S;
{Journal}: Acta Neurochir (Wien)
{Volume}: 166
{Issue}: 1
{Year}: 2024 Jul 30
{Factor}: 2.816
{DOI}: 10.1007/s00701-024-06162-3
{Abstract}: <B>OBJECTIVE: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.