Effects of three-dimensional angiography on the coiling of cerebral aneurysms

To assess how information acquired with three-dimensional angiography (3DA) affects the endovascular management of cerebral aneurysms.

The role of 3DA in 50 aneurysm cases was assessed with respect to five predetermined factors, i.e., whether 3DA facilitated treatment, modified the coil embolization technique, made treatment unnecessary or unjustified by revealing new information, suggested a potential treatment failure or complication, or did not contribute to endovascular management.

Findings for a total of 46 patients with 50 aneurysms who underwent 3DA in the course of their endovascular treatment were analyzed. Overall, 3DA facilitated coiling in 25 cases, modified the treatment technique in 11 cases, eliminated the need for treatment in 9 cases, and suggested a potential treatment complication in 5 cases. 3DA was deemed useful in the management of all cases, and in no case was its use associated with a complication. Specifically, 3DA facilitated treatment by delineating the optimal fluoroscopic tube angulation for coiling, modified treatment by revealing anatomic characteristics that would require balloon remodeling or stent assistance, obviated treatment by excluding the possibility of an aneurysm or by identifying unfavorable anatomic features, and predicted a treatment complication by revealing an associated vessel that was likely to be compromised with coiling of the aneurysm.

3DA enhances our ability to treat aneurysms endovascularly. Most importantly, aneurysm treatment may be facilitated, modified, or proven unnecessary because of vital information obtained with 3DA.