Luke Tomycz MD, Abstract Co-Author: Nothing to Disclose

Catherine Renee Hawley BS, Presenter: Nothing to Disclose

Neil Bansal, Abstract Co-Author: Nothing to Disclose

Michael Ayad MD, Abstract Co-Author: Nothing to Disclose

Robert Mericle MD, Abstract Co-Author: Nothing to Disclose

Based on numerous reports citing high sensitivity and specificity of non-invasive imaging (e.g. CTA or MRA) in the detection of intracranial aneurysms, it has become increasingly difficult to justify the role of conventional angiography (DSA) for diagnostic purposes. We sought to determine the proportion of patients for whom the additional information gleaned from 3D rotational DSA (3DRA) led to a change in treatment.

We analyzed the medical records of the last 361 consecutive patients referred to a neurosurgeon at Vanderbilt University Medical Center for evaluation of “possible intracranial aneurysm” or subarachnoid hemorrhage. Only those who underwent non-invasive vascular imaging within 3 months prior to DSA were included in the study. For asymptomatic patients without a history of subarachnoid hemorrhage (SAH), aneurysms less than 5 mm were typically followed conservatively. Treatment, meanwhile, was generally advocated for patients with unruptured aneurysms that measured 5 mm or larger in greatest diameter. Treatment was advocated for any aneurysm in the setting of acute SAH, regardless of size.

In those who underwent CTA or MRA prior to DSA, the plan of treatment was changed in 19/90 (21.1%) and 20/71 (28.2%), respectively, based on new information gleaned from DSA. Vessel loops, infundibuli, and fenestrations were among the benign anatomic variants erroneously interpreted as "possible aneurysm" by non-invasive imaging. Vessel infundibuli were discovered in 3 (1.8%) of the patients in this study after performing 3DRA. One fenestration (0.6%) and three vessel loops (1.8%) were discovered within the entire cohort. The most common reason for a change in the treatment plan was because of a discrepancy in the size measurement when comparing non-invasive imaging to 3DRA.

In a "real-world" analysis of patients with intracranial aneurysms, DSA continues to play a role in determining the optimal management strategy.

Despite greater invasiveness and increased risk to the patient, DSA remains a useful and important tool in the detection and treatment of cerebral aneurysms.

Tomycz, L, Hawley, C, Bansal, N, Ayad, M, Mericle, R, A Practical Comparison of Noninvasive Imaging to Conventional Catheter Angiography in the Diagnosis of Cerebral Aneurysms: A Retrospective, Single Center Analysis.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11011309.html