{"id":"f9ffefa3-bd07-41f1-a97a-8a11474f3642","slug":"real-world-comparison-of-non-invasive-imaging-to-conventional-catheter-angiography-in-the-diagnosis-of-cerebral-aneurysms","title":"“Real-world” comparison of non-invasive imaging to conventional catheter angiography in the diagnosis of cerebral aneurysms","authors":["Luke Tomycz","Neil K. Bansal","Catherine R. Hawley","Tracy L. Goddard","Michael J. Ayad","Robert A. Mericle"],"abstract":"Background: Based on numerous reports citing high sensitivity and specificity of non-invasive imaging [e.g. computed tomography angiography (CTA) or magnetic resonance angiography (MRA)] in the detection of intracranial aneurysms, it has become increasingly difficult to justify the role of conventional angiography [digital subtraction angiography (DSA)] for diagnostic purposes. The current literature, however, largely fails to demonstrate the practical application of these technologies within the context of a \"real-world\" neurosurgical practice. We sought to determine the proportion of patients for whom the additional information gleaned from 3D rotational DSA (3DRA) led to a change in treatment. Methods: We analyzed the medical records of the last 361 consecutive patients referred to a neurosurgeon at our institution for evaluation of \"possible intracranial aneurysm\" or subarachnoid hemorrhage (SAH). Only those who underwent non-invasive vascular imaging within 3 months prior to DSA were included in the study. For asymptomatic patients without a history of SAH, aneurysms less than 5 mm were followed conservatively. Treatment was advocated for patients with unruptured, non-cavernous aneurysms measuring 5 mm or larger and for any non-cavernous aneurysm in the setting of acute SAH. Results: For those who underwent CTA or MRA, the treatment plan was changed in 17/90 (18.9%) and 22/73 (30.1%), respectively, based on subsequent information gleaned from DSA. Several reasons exist for the change in the treatment plan, including size and location discrepancies (e.g. cavernous versus supraclinoid), or detection of a benign vascular variant rather than a true aneurysm. Conclusions: In a \"real-world\" analysis of intracranial aneurysms, DSA continues to play an important role in determining the optimal management strategy.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/f9ffefa3-bd07-41f1-a97a-8a11474f3642/featured/hero-1782421051353.png","publishDate":"2011-09-30T00:00:00.000Z","doi":"10.4103/2152-7806.85607","categories":["Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2015/05/3587/SNI-2-134.pdf"}