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[Postoperative three-dimensional CT angiography (3D-CTA) in evaluation of proximal clipping for ruptured vertebral
Insights
Three-dimensional computed tomographic angiography (3D-CTA) effectively evaluates ruptured vertebral artery aneurysms after proximal clipping. This minimally invasive technique aids in crucial postoperative assessment, especially for patients in poor condition.
Area of Science:
- Neurosurgery
- Vascular Imaging
- Radiology
Background:
- Intra-arterial angiography is the gold standard for cerebrovascular issues.
- Three-dimensional computed tomographic angiography (3D-CTA) is emerging as a screening tool for cerebrovascular disease.
- 3D-CTA generates 3D images from contrast-enhanced CT scans.
Observation:
- 3D-CTA was used for preoperative and postoperative evaluation of patients undergoing proximal clipping of ruptured vertebral artery aneurysms.
- Six patients (33-61 years; 5 male, 1 female) with saccular (1) and fusiform (5) aneurysms were studied.
- Postoperative conventional angiography showed no aneurysm delineation in 5 cases, correlating with 3D-CTA findings.
Findings:
- Postoperative 3D-CTA results corresponded well with conventional angiography.
- 3D-CTA visualized an aneurysm in one patient where conventional angiography was not feasible.
- Rebleeding after proximal clipping can occur within a week, necessitating prompt postoperative evaluation.
Implications:
- 3D-CTA is a valuable, minimally invasive tool for evaluating ruptured vertebral artery aneurysms post-proximal clipping.
- The ability to perform repeated 3D-CTA scans is beneficial, particularly for unstable patients.
- Early postoperative assessment using 3D-CTA is crucial for managing ruptured vertebral artery aneurysms treated with proximal clipping.
Abstract:
At present, intra-arterial angiography remains the gold standard for most cerebrovascular problems. Recently, three-dimensional computed tomographic angiography (3D-CTA) has been reported as a screening method for the diagnosis of cerebrovascular disease. This imaging modality uses the information obtained on a contrast-enhanced CT scan to generate three-dimensional images of the cerebrovascular system. We performed 3D-CTA in the preoperative and postoperative evaluation of patients undergoing proximal clipping of ruptured vertebral artery aneurysms in addition to conventional cerebral angiography. In this study, the value of 3D-CTA after proximal clipping of ruptured vertebral artery aneurysm was evaluated retrospectively. Six patients were examined with a spinal CT (HITACHI CT-W 3000) after intravenous bolus injection of 100 ml contrast material (Iohexhol 300 mgI/ml) at the rate of 2 ml/s with a 25 second pre-scanning delay. The images of 3D-CTA were reconstructed using a new 3D-volume-render (Voxel Transmission) technique. The ages of the six patients ranged from 33 to 61 years and five cases were males and one case was female. Only one patient had a saccular aneurysm and the other five had fusiform aneurysms. Two patients underwent emergency operations within 4 days, and the other four had delayed operations. The outcome was good recovery in five cases and severe disability in one case. Postoperative conventional cerebral angiography demonstrated no delineation of the aneurysms in five cases. These results correspond well to postoperative 3D-CTA. Postoperative conventional cerebral angiography could not be performed in only one patient, but the aneurysm was visualized on the third postoperative 3D-CTA. Proximal clipping is still one of the therapeutic options for ruptured vertebral aneurysms, but some reports emphasized the possibility of rebleeding after proximal clipping of vertebral artery aneurysms. The rebleeding occurred within 1 week after proximal clipping in 6 of 9 cases (66.7%), and the prognoses were extremely poor. Therefore, in patients selected for proximal clipping, it is necessary to undertake postoperative evaluation of the aneurysm within one week after proximal clipping. 3D-CTA is minimally invasive and can be easily performed repeatedly, even if the patients are in a poor condition. In conclusion, 3D-CTA is very useful especially for evaluation of ruptured vertebral artery aneurysms following proximal clipping.