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"Real-world" comparison of non-invasive imaging to conventional catheter angiography in the diagnosis of cerebral aneurysms.
MedLine Citation:
PMID:  22059129     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Luke Tomycz; Neil K Bansal; Catherine R Hawley; Tracy L Goddard; Michael J Ayad; Robert A Mericle
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Publication Detail:
Type:  Journal Article     Date:  2011-09-30
Journal Detail:
Title:  Surgical neurology international     Volume:  2     ISSN:  2152-7806     ISO Abbreviation:  Surg Neurol Int     Publication Date:  2011  
Date Detail:
Created Date:  2011-11-07     Completed Date:  2011-11-10     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101535836     Medline TA:  Surg Neurol Int     Country:  India    
Other Details:
Languages:  eng     Pagination:  134     Citation Subset:  -    
Affiliation:
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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