Discrepancy between two-dimensional and three-dimensional digital subtraction angiography for the planning of endovascular coiling of small cerebral aneurysms <5 mm. Issue 6 (December 2020)

• Record Type: Journal Article
• Authors: Wu, Te-Chang; Tsui, Yu-Kun; Chen, Tai-Yuan; Ko, Ching-Chung; Lin, Chien-Jen; Chen, Jeon-Hor; Lin, Ching-Po
• Is Part Of: Interventional neuroradiology. Volume 26:Issue 6(2020:Dec.)
• Page Start: 733
• Page End: 740
• Publication Date: 2020-12
• Subjects: Cerebral aneurysm -- angiography -- endovascular coiling; Nervous system -- Interventional radiology -- Periodicals; Nervous system -- Radiography -- Periodicals; Nervous System Diseases -- Periodicals -- radiography; Neuroradiography -- Periodicals; Radiography, Interventional -- Periodicals; Nervous system -- Radiography; Periodicals; 617.4805
• DOI: 10.1177/1591019920925706
• Languages: English
• ISSNs: 1591-0199

Abstract

Background: To investigate the discrepancy between two-dimensional digital subtraction angiography and three-dimensional rotational angiography for small (&lt;5 mm) cerebral aneurysms and the impact on decision making among neuro-interventional experts as evaluated by online questionnaire. Materials and methods: Eight small (&lt;5 mm) ruptured aneurysms were visually identified in 16 image sets in either two-dimensional or three-dimensional format for placement in a questionnaire for 11 invited neuro-interventionalists. For each set, two questions were posed: Question 1: &quot;Which of the following is the preferred treatment choice: simple coiling, balloon remodeling or stent assisted coiling?&quot;; Question 2: &quot;Is it achievable to secure the aneurysm with pure simple coiling?&quot; The discrepancies of angio-architecture parameters and treatment choices between two-dimensional-digital subtraction angiography and three-dimensional rotational angiography were evaluated. Results: In all eight cases, the neck images via three-dimensional rotational angiography were larger than two-dimensional-digital subtraction angiography with a mean difference of 0.95 mm. All eight cases analyzed with three-dimensional rotational angiography, but only one case with two-dimensional-digital subtraction angiography were classified as wide-neck aneurysms with dome-to-neck ratio &lt; 1.5. The treatment choices based on the two-dimensional or three-dimensional information were different in 56 of 88 (63.6%) paired answers. Simple coiling was the preferred choice in 66 (75%) and 26 (29.6%) answers based on two-dimensional and three-dimensional information, respectively. Three types of angio-architecture with a narrow gap between the aneurysm sidewall and parent artery were proposed as an explanation for neck overestimation with three-dimensional rotational angiography. Conclusions: Aneurysm neck overestimation with three-dimensional rotational angiography predisposed neuro-interventionalists to more complex treatment techniques. Additional two-dimensional information is crucial for endovascular treatment planning for small cerebral aneurysms.