ArticleOperative neurosurgery (Hagerstown, Md.)2021
Value of 3-Dimensional Digital Subtraction Angiography for Detection and Classification of Intracranial Aneurysm Remnants After Clipping.
Article in Operative neurosurgery (Hagerstown, Md.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 10 citations in OpenAlex.
- [Association between early stenosis and temporary clipping in treated cerebral aneurysms].Revista medica del Instituto Mexicano del Seguro Social · 2026Article
- Classification of intracranial aneurysm remnants after clipping in the era of three-dimensional digital subtraction angiography.Acta neurochirurgica · 2025Article
- Response to "Classification of intracranial aneurysm remnants after clipping in the era of three-dimensional digital subtraction angiography".Acta neurochirurgica · 2025Article
- Emergency neurosurgical hybrid operating platform for acute intracranial hemorrhage (E-HOPE).Chinese neurosurgical journal · 2024Article
- Is there any risk for recurrence of a completely clipped intracranial aneurysm?Neurosurgical review · 2023Article
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundThe current gold standard for evaluation of the surgical result after intracranial aneurysm (IA) clipping is two-dimensional (2D) digital subtraction angiography (DSA). While there is growing evidence that postoperative 3D-DSA is superior to 2D-DSA, there is a lack of data on intraoperative comparison.
objectiveTo compare the diagnostic yield of detection of IA remnants in intra- and postoperative 3D-DSA, categorize the remnants based on 3D-DSA findings, and examine associations between missed 2D-DSA remnants and IA characteristics.
methodsWe evaluated 232 clipped IAs that were examined with intraoperative or postoperative 3D-DSA. Variables analyzed included patient demographics, IA and remnant distinguishing characteristics, and 2D- and 3D-DSA findings. Maximal IA remnant size detected by 3D-DSA was measured using a 3-point scale of 2-mm increments.
resultsAlthough 3D-DSA detected all clipped IA remnants, 2D-DSA missed 30.4% (7 of 23) and 38.9% (14 of 36) clipped IA remnants in intraoperative and postoperative imaging, respectively (95% CI: 30 [ 12, 49] %; P-value .023 and 39 [23, 55] %; P-value = <.001), and more often missed grade 1 (< 2 mm) clipped remnants (odds ratio [95% CI]: 4.3 [1.6, 12.7], P-value .005).
conclusionCompared with 2D-DSA, 3D-DSA achieves a better diagnostic yield in the evaluation of clipped IA. Our proposed method to grade 3D-DSA remnants proved to be simple and practical. Especially small IA remnants have a high risk to be missed in 2D-DSA. We advocate routine use of either intraoperative or postoperative 3D-DSA as a baseline for lifelong follow-up of clipped IA.
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