Early Experience Studying Cerebral Aneurysms with Rotational and Threedimensional Angiography and Review of CT and MR Angiography Literature

Abstract

From september 2000 to september 2001, 32 consecutive patients with ruptured intracranial aneurysms were examined with rotational and 3D reconstruction angiography using an Integris V5000 Philips Medical System: 39 aneurysms were detected. After a selective cerebral artery was catheterized with a 5F or 4F-catheter, 35 ml of contrast medium was intra-arterially administered at a rate of 4 ml/s and a 180 degrees rotational angiography was performed in eight seconds. This information was transferred to a computer (Silicon Graphics Octane) with software (Integris 3DRA, Philips Integris Systems) and a three-dimensional reconstruction was made. The information provided by Angio-3D was useful for evaluating the parent artery, aneurysmal sac, aneurysmal neck and arterial branches. It was also very useful in selecting the therapeutic method. For open surgery, this technique provides preoperative images that are useful for planning microsurgical approaches, especially in cases of large aneurysm showing complex surrounding arteries. For endovascular embolization, various anatomic characteristics of the aneurysm such as neck and sac size, shape, lobularity, parent artery and arterial branches adjacent to the aneurysmal neck must be demonstrated. This is very important to determine the best projection for embolization and to avoid multiple series. This is also essential in the choice of the first coil to create a good basket producing total occlusion. Microaneurysms are demonstrated well with this technique whereas this is difficult to do with conventional arteriography. The Angio-RM and Angio-CT literature show a lower sensitivity and specificity in comparasion with our experience with 3D IA-ROT-DSA. For this reason, we believe that 3D IA-ROTDSA is now the gold standard for patients presenting intracranial aneurysms.

Figure 1

In this posterior communicating aneurysm, we can evaluate its characteristics (neck, sac, parent and efferent arteries) from any angle and provide anatomical information useful for endovascular or surgical planning.

Figure 2

We can see the neck, sac, parent and efferent arteries of this aneurysm of the Middle Cerebral Artery. This information advocates the correct choice of initial coil to build a basket permitting occlusion of the aneurysm.

Figure 2

We can see the neck, sac, parent and efferent arteries of this aneurysm of the Middle Cerebral Artery. This information advocates the correct choice of initial coil to build a basket permitting occlusion of the aneurysm.

Figure 3

Post-clipping control of a giant aneurysm of the one branch of the middle cerebral artery. We can evaluate its characteristics from any angle.

Figure 4

3D IA-ROT-DSA clearly shows the best projection to disclose the anatomical relationship between neck, parent and efferent arteries and we can measure key points such as diameter of aneurysm sac and neck. A useful aspect of this technique is the capacity to provide accurate angulation and rotation degrees of the C-arm to obtain the best projection for embolization.

Figure 5

The three-dimensional nature of this technique and the ability to view the three-dimensional imaging volume at multiple angles was helpful in identifying the relationship of this aneurysm of the basilar artery and evaluates the neck of the aneurysm beneath the overlapping tortuous basilar artery and demonstrates a second aneurysm of the posterior inferior cerebellar artery. This ability to depict the aneurysmal neck and the projection of the aneurysm relative to the parent artery is advantageous for evaluating the outcome of clipping or embolization of the aneurysm. In this particular case, this information advocates the best protection and the correct choice of initial coil to build a basket permitting total occlusion of the aneurysm.

Figure 5

The three-dimensional nature of this technique and the ability to view the three-dimensional imaging volume at multiple angles was helpful in identifying the relationship of this aneurysm of the basilar artery and evaluates the neck of the aneurysm beneath the overlapping tortuous basilar artery and demonstrates a second aneurysm of the posterior inferior cerebellar artery. This ability to depict the aneurysmal neck and the projection of the aneurysm relative to the parent artery is advantageous for evaluating the outcome of clipping or embolization of the aneurysm. In this particular case, this information advocates the best protection and the correct choice of initial coil to build a basket permitting total occlusion of the aneurysm.

Figure 6

3D IA-ROT-DSA demonstrates this microaneurysm that conventional angiography failed to reveal.We can see the surgical verification.