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. 2024 Jul 30;166(1):309.
doi: 10.1007/s00701-024-06162-3.

Intra-aneurysmal contrast agent stasis during intraoperative digital subtraction angiography may predict long-term occlusion after clipping

Basil E Grüter  1   2 , Kristina Catalano  3 , Javier Anon  4 , Philipp Gruber  4 , Arjun Thanabalasingam  4 , Lukas Andereggen  5 , Gerrit A Schubert  3   6 , Luca Remonda  7 , Serge Marbacher  5
Affiliations

Intra-aneurysmal contrast agent stasis during intraoperative digital subtraction angiography may predict long-term occlusion after clipping

Basil E Grüter et al. Acta Neurochir (Wien). .

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Intracranial aneurysm; Intraoperative DSA; Occlusion; Remnant; Spontaneous; Thrombosis.

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