Pre-embolization study of ruptured cerebral aneurysm with rotational and 3D reconstruction angiography

Abstract

From September 2000 to May 2001, 23 patients were examined with rotational and 3D reconstruction angiography using an Integris V5000 Philips Medical System; there were 29 aneurysms were detected. After a selected cerebral artery was catheterized with a 5F or a F catheter, 35 ml contrast medium was intra-arterially administrated at a rate of 4 ml/s and a 180° rotational angiography was performed in 8 seconds. The information provided by angio-3D was useful for evaluating the parent artery, aneurysmal sac, aneurysmal neck, and arterial branches. This information was also very useful for selecting the best therapeutic method. In 15 patients, endovascular embolization with Guglielmi detachable coils (GDCs) was performed with a total occlusion (100%) in 13, subtotal (95–99%) in 1, and incomplete (<95%) in 1. In 11 patients, clipping was performed because radiological findings revealed that those aneurysms were not suitable for endovascular treatment. One patient with multiple aneurysms was treated with embolization with GDCs and clipping. In two patients, a conservative treatment was determined, and one patient is awaiting an endovascular treatment with stenting and coiling. This technique provides preoperative images that are useful for planning microsurgical approaches, especially in cases of large or giant aneurysm or in cases showing complex surrounding arteries. For endovascular embolization, various anatomic characteristics of the aneurysm such as neck and sac size, shape, lobularity, parent artery and arterial branches adjacent to the aneurysmal neck must be determined.