Intracranial aneurysms: clinical value of 3D digital subtraction angiography in the therapeutic decision and endovascular treatment.
OBJECTIVE
To evaluate three-dimensional (3D) digital subtraction angiography (DSA) as a supplement to two-dimensional (2D) DSA in the endovascular treatment (EVT) of intracranial aneurysms.


METHODS
In 22 ruptured aneurysms, neck visualization, aneurysm shape, and EVT feasibility were analyzed at 2D DSA (anteroposterior, lateral, and rotational views) and at maximum intensity projection (MIP) and surface shaded display (SSD) 3D DSA. The possibility of obtaining a working view for EVT at 3D DSA and the relevance of measurements in choosing the first coil also were assessed.


RESULTS
Two-dimensional DSA images clearly depicted the aneurysm neck in four of 22 aneurysms; MIP images, in 10; and SSD images, in 21, but SSD led to overestimation of the neck size in one aneurysm. Aneurysm shape was precisely demonstrated in five of 22 aneurysms at 2D DSA, in eight at MIP, and in all cases at SSD. In two of 22 aneurysms, EVT seemed to be nonfeasible at 2D DSA; however, SSD demonstrated feasibility and EVT was successfully performed. In one aneurysm, only SSD demonstrated the extension of the neck to a parent vessel, which was proved at surgery. Working views for EVT were deduced from 3D DSA findings in 20 of 21 aneurysms. The choice of the first coil was correct in 19 of 21 aneurysms.


CONCLUSIONS
Three-dimensional DSA is valuable for evaluating the potential for EVT, finding a working view, and performing accurate measurements.
Departments of Diagnostic and Interventional Neuroradiology, University Hospital, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France. r.anxionnat@chu-nancy.fr
R
R
Anxionnat
S
S
Bracard
X
X
Ducrocq
Y
Y
Trousset
L
L
Launay
E
E
Kerrien
M
M
Braun
R
R
Vaillant
F
F
Scomazzoni
A
A
Lebedinsky
L
L
Picard
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D014656:Vascular Surgical Procedures / Q000379:methods*