Early Postoperative Cerebral Angiography After Clipping in Patients with Ruptured Aneurysm : its Usefulness and Indications

Abstract

Objective : The objective of this study was to determine whether postoperative conventional angiography conducted during the early stage after aneurysm clipping is useful in patients with ruptured aneurysm. Methods : Between May 2008 and November 2009, 57 patients who presented with ruptured cerebral aneurysms were treated with surgical clipping. Among them,a consecutive series of 45 patients who underwent postoperative angiography was analyzed retrospectively. Parameters of the postoperative angiography were categorized as incomplete clippings, vasospasms, vascular compromises, or other aneurysms. Results : The average age of the patients was 49.2 years and ranged from 18 to 72 years. The average timing of the post-operative angiography after the onset of hemorrhage was 11.1 (± 5.6) days. Complete aneurysm closure was achieved in 43(95%) patients. A neck remnant aneurysm was discovered in two patients and a fundus remnant was revealed in one patient. Twelve (27%) patients showed angiographic vasospasms and seven needed angioplasty. Four cases (9%) revealed either parent artery stenosis or branch occlusions, and two of them (4%) were clinically significant. Two cases showed aneurysms at another location, one of which was a ruptured aneurysm. Overall, 21 (47%) patients exhibited significant findings on the postoperative angiography. Conclusions : Our retrospective analysis revealed that postoperative angiography might be valuable in patients with ruptured aneurysms, especially in the acute stage, in order to determine the presence of vasospasms, incomplete clippings, vascular compromises, or other aneurysms that were missed at the initial cerebral angiography.