IvACT after aneurysm clipping as an alternative to digital subtraction angiography--first experiences

After clipping of intracranial aneurysms, digital subtraction angiography (DSA) is recommended for the proof of complete aneurysm occlusion or identification of aneurysm remnants, especially in cases with a more complex angioarchitecture or a difficult operative course. The aim of this study was to evaluate if postoperative intravenous angiographic computed tomography (ivACT) could be a diagnostic alternative in cases of contraindications for DSA.

13 patients (12 female, 1 male) underwent surgical clipping of 5 ruptured and 10 innocent aneurysms. Postoperative ivACT was performed in all patients due to refusal or contraindications for DSA.

12 patients had almost complete aneurysm clipping, while 1 patient's was incomplete, which was diagnosed by ivACT and confirmed by subsequent postoperative digital subtraction angiography (DSA), which had been accepted by the patient after clarification of the postoperative findings.

This study illustrates the efficacy of ivACT for postoperative control of surgically treated aneurysms. The quality of ivACT generated images seems to be sufficient in the detection of residual aneurysms after clipping. In cases with inconclusive results, postoperative DSA should be performed to obtain further details.