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Neuroradiology

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01-10-2008 | Diagnostic Neuroradiology

Is digital substraction angiography still needed for the follow-up of intracranial aneurysms treated by embolisation with detachable coils?

Authors: Boris Lubicz, Carine Neugroschl, Laurent Collignon, Olivier François, Danielle Balériaux

Published in: Neuroradiology | Issue 10/2008

Abstract

Introduction

Follow-up of intracranial aneurysms treated by embolisation with detachable coils is mandatory to detect a possible recanalisation. The aim of this study was to compare contrast-enhanced magnetic resonance angiography (CE-MRA) with digital substraction angiography (DSA) used to detect aneurysm recanalisation to determine if DSA is still needed during follow-up.

Materials and methods

From May 2006 to May 2007, 55 patients with 67 aneurysms were treated by endosaccular coiling with (n = 9) or without (n = 58) an adjunctive stent. Follow-up imaging protocol included MRA at 6 and 12 months and a DSA at 12 months or earlier if a major recanalisation was identified on the 6-month MRA. Two neuroradiologists independently reviewed MRA images (readers 1 and 2) and two other reviewed DSA images.

Results

Follow-up DSA showed stability of the aneurysm occlusion in 52 cases, recanalisation in 14 cases, and further thrombosis in one. On CE-MRA, both readers identified all recanalisations but one (sensitivity of 93%) as they missed a major recanalisation in a 2-mm ruptured aneurysm. There were two false-positive evaluations by reader 1 and three for reader 2. Mean specificity of CE-MRA to detect aneurysm recanalisation was 95.5%.

Conclusion

CE-MRA is accurate to detect aneurysm recanalisation after embolisation with detachable coils. CE-MRA may be proposed as first-intention imaging technique for their follow-up. However, its sensitivity and specificity remain inferior to that of DSA and major recurrences may be missed in very small aneurysms. Therefore, a single DSA remains mandatory during the imaging follow-up.

International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2002) ISAT of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial. Lancet 360:1267–1274 doi:10.1016/S0140-6736(02)11314-6 CrossRef

International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2005) ISAT of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809–817 doi:10.1016/S0140-6736(05)67214-5 CrossRef

Raymond J, Guilbert F, Weill A et al (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:1398–1403 doi:10.1161/01.STR.0000073841.88563.E9 PubMedCrossRef

Cognard C, Weill A, Spelle L et al (1999) Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 212:348–356PubMed

Mayberg MR, Batjer HH, Dacey et al (1994) Guidelines for the management of aneurysmal subarachnoid hemorrhage, a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 25:2315–2328PubMed

Earnest F, Forbes G, Sandok B et al (1984) Complications of cerebral angiography: prospective assessment of the risk. AJR 142:247–253PubMed

Derdeyn CP, Graves VB, Turksi PA, Masaryk AM, Strother CM (1997) MR angiography of saccular aneurysms after treatment with Guglielmi detachable coils: preliminary experience. AJNR Am J Neuroradiol 18:279–286PubMed

Gonner F, Heid O, Remonda L et al (1998) MR angiography with ultrashort echo time in cerebral aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol 19:1324–1328PubMed

Kahara VJ, Seppanen SK, Ryymin PS, Mattila P, Kuurne T, Laasonen EM (1999) MR angiography with three-dimensional time-of-flight and targeted maximum-intensity-projection reconstructions in the follow-up of intracranial aneurysms embolized with Guglielmi detachable coils. AJNR Am J Neuroradiol 20:1470–1475PubMed

10.

Anzalone N, Righi C, Simionato F et al (2000) Three-dimensional time-of-flight MR angiography in the evaluation of intracranial aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol 21:746–752PubMed

11.

Boulin A, Pierot L (2001) Follow-up of intracranial aneurysms treated with detachable coils: comparison of gadolinium-enhanced 3D time-of-flight MR angiography and digital substraction angiography. Radiology 219:108–113PubMed

12.

Weber W, Yousry TA, Felber SR et al (2001) Non-invasive follow-up of GDC-treated saccular aneurysms by MR angiography. Eur Radiol 11:1792–1797 doi:10.1007/s003300000741 PubMedCrossRef

13.

Westerlaan HE, Van der Vliet AM, Hew JM et al (2005) Time-of-flight MR angiography in the follow-up of intracranial aneurysms treated with Guglielmi detachable coils. Neuroradiology 47:622–629 doi:10.1007/s00234-005-1395-3 PubMedCrossRef

14.

Yamada N, Hayashi K, Murao K, Higashi M, Iihara K (2004) Time-of-flight MR angiography targeted to coiled intracranial aneurysms is more sensitive to residual flow than is digital subtraction angiography. AJNR Am J Neuroradiol 25:1154–1157PubMed

15.

Metens T, Rio F, Balériaux D, Roger T, David P, Rodesch G (2000) Intracranial aneurysms: detection with dynamic gadolinium-enhanced three-dimensional MR angiography—initial results. Radiology 216:39–46PubMed

16.

Gauvrit JY, Leclerc X, Pernodet M et al (2005) Intracranial aneurysms treated with Guglielmi detachable coils: usefulness of 6-month imaging follow-up with contrast-enhanced MR angiography. AJNR Am J Neuroradiol 26:515–521PubMed

17.

Leclerc X, Navez JF, Gauvrit JY, Lejeune JP, Pruvo JP (2002) Aneurysms of the anterior communicating artery treated with Guglielmi detachable coils: follow-up with contrast-enhanced MR angiography. AJNR Am J Neuroradiol 23:1121–1127PubMed

18.

Cottier JP, Bleuzen-Couthon A, Gallas S et al (2003) Intracranial aneurysms treated with Guglielmi detachable coils: is contrast material necessary in the follow-up with 3D time-of-flight MR angiography? AJNR Am J Neuroradiol 24:1797–1803PubMed

19.

Farb RI, Nag S, Scott JN et al (2005) Surveillance of intracranial aneurysms treated with detachable coils: a comparison of MRA techniques. Neuroradiology 47:507–515 doi:10.1007/s00234-005-1375-7 PubMedCrossRef

20.

Pierot L, Delcourt C, Bouquigny F et al (2006) Follow-up of intracranial aneurysms selectively treated with coils: prospective evaluation of contrast-enhanced MR angiography. AJNR Am J Neuroradiol 27:744–749PubMed

21.

Gauvrit JY, Leclerc X, Caron S, Taschner C, Lejeune JP, Pruvo JP (2006) Intracranial aneurysms treated with GDC: imaging follow-up with contrast-enhanced MR angiography. Stroke 37:1033–1037 doi:10.1161/01.STR.0000209236.06451.3b PubMedCrossRef

22.

Kwee TC, Kwee RM (2007) MR angiography in the follow-up of intracranial aneurysms treated with Guglielmi Detachable Coils: systematic review and meta-analysis. Neuroradiology 49:703–713 doi:10.1007/s00234-007-0266-5 PubMedCrossRef

23.

Lovblad KO, Yilmaz H, Chouiter A et al (2006) Intracranial aneurysm stenting: follow-up with MR angiography. J Magn Reson Imaging 24:418–422 doi:10.1002/jmri.20642 PubMedCrossRef

24.

Lubicz B, Levivier M, Sadeghi N, Emonts P, Balériaux D (2007) Immediate intracranial aneurysms occlusion after embolisation with detachable coils: a comparison between MR angiography and intra-arterial digital substraction angiography. J Neuroradiol 34:190–197PubMed

25.

Hunt W, Hess R (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 8:14–20

26.

Gulielmi G, Vinuela F, Dion J, Duckwiler G (1991) Electrothrombosis of saccular aneurysms via endovascular approach—part 2: preliminary clinical experience. J Neurosurg 75:8–14

27.

Guglielmi G, Vinuela F, Duckwiler G et al (1992) Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 77:515–524PubMed

28.

Vinuela F, Duckwiler G, Mawad M (1997) Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86:475–482PubMedCrossRef

29.

Moret J, Cognard C, Weill A, Castaings L, Rey A (1997) The reconstruction technique in the treatment of wide-neck intracranial aneurysms: long-term angiographic and clinical results. J Neuroradiol 24:30–44PubMed

30.

Lubicz B, Lefranc F, Bruneau M, Balériaux D, De Witte O (2008) Balloon-assisted coiling of intracranial aneurysms is not associated with higher complication rate. Neuroradiology (May):14 (in press)

31.

Alfke K, Straube T, Dörner L, Mehdorn HM, Jansen O (2004) Treatment of intracranial broad-neck aneurysms with a new self-expanding stent and coil embolization. AJNR Am J Neuroradiol 25:584–591PubMed

32.

Lubicz B, Leclerc X, Levivier M et al (2006) Retractable self-expandable stent for endovascular treatment of wide-necked intracranial aneurysms: preliminary experience. Neurosurgery 58:451–457PubMed

33.

Roy D, Milot G, Raymond J (2001) Endovascular treatment of unruptured aneurysms. Stroke 32:1998–2004 doi:10.1161/hs0901.095600 PubMedCrossRef

34.

CARAT Investigators (2006) Rates of delayed rebleeding from intracranial aneurysms are low after surgical and endovascular treatment. Stroke 37:1437–1442 doi:10.1161/01.STR.0000221331.01830.ce CrossRef

35.

Kang HS, Moon WJ, Roh HG et al (2007) MR angiographic evaluation is limited in intracranial aneurysms embolized with Nexus coils. Neuroradiology 50:171–178 doi:10.1007/s00234-007-0320-3 PubMedCrossRef

36.

Majoie CB, Sprengers ME, van Rooij WJ et al (2005) MR angiography at 3T versus DSA in the follow-up of intracranial aneurysms treated with detachable coils. AJNR Am J Neuroradiol 26:1349–1356PubMed

37.

Urbach H, Dorenbeck U, von Falkenhausen M et al (2008) Three-dimensional Time-Of-Flight MR angiography at 3 T compared to DSA in the follow-up of ruptured and coiled intracranial aneurysms: a prospective study. Neuroradiology 50:383–389 doi:10.1007/s00234-007-0355-5 PubMedCrossRef

38.

Buhk JH, Kallenberg K, Mohr A, Dechent P, Knauth M (2008) No advantage of Time-Of-Flight MR angiography at 3 Tesla compared to 1.5 Tesla in the follow-up after endovascular treatment of cerebral aneurysms. Neuroradiology (Jun):4 (in press)

39.

Anzalone N, Scomazzoni F, Cirillo M et al (2008) Follow-up of coiled cerebral aneurysms at 3T: comparison of 3D-Time-Of-Flight MR angiography and contrast-enhanced MR angiography. AJNR Am J Neuroradiol (Jun):12 (in press)

40.

Cloft HJ, Joseph GJ, Dion JE (1999) Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation: a meta-analysis. Stroke 30:317–320PubMed

41.

Willinsky RA, Taylor SM, terBrugge K, Farb RI, Tomlinson G, Montanera W (2003) Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology 227:522–528 doi:10.1148/radiol.2272012071 PubMedCrossRef

Title: Is digital substraction angiography still needed for the follow-up of intracranial aneurysms treated by embolisation with detachable coils?
Authors: Boris Lubicz
Carine Neugroschl
Laurent Collignon
Olivier François
Danielle Balériaux
Publication date: 01-10-2008
Publisher: Springer-Verlag
Published in: Neuroradiology / Issue 10/2008
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-008-0450-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Is digital substraction angiography still needed for the follow-up of intracranial aneurysms treated by embolisation with detachable coils?

Abstract

Introduction

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

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