Document Detail


Role of angiography following aneurysm surgery.
MedLine Citation:
PMID:  8246049     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The postoperative angiograms in 66 patients who underwent craniotomy for clipping of 78 cerebral aneurysms were reviewed. Indications for urgent postoperative angiography included neurological deficit or repeat subarachnoid hemorrhage. Routine postoperative angiograms were carried out in the remaining patients. Postoperative angiograms were reviewed to determine the incidence of unexpected findings such as unclipped aneurysms, residual aneurysms, and unforeseen major vessel occlusions. Logistic regression analysis was used to test if the following were factors that predicted an unexpected finding on postoperative angiography: aneurysm site or size; the intraoperative impression that residual aneurysm was left or a major vessel was occluded; intraoperative aneurysm rupture; opening or needle aspiration of the aneurysm after clipping; or development of a new neurological deficit after surgery. Kappa values were calculated to assess the agreement between some of these clinical factors and unexpected angiographic findings. Unexpected residual aneurysms were seen in three (4%) of the 78 occlusions. In addition, three aneurysms were completely unclipped (4%); these three patients were returned to the operating room and had their aneurysms successfully obliterated. There were nine unexpected major vessel occlusions (12%); six of these resulted in disabling stroke and two patients died. Of six major arteries considered to be occluded intraoperatively and shown to be occluded by postoperative angiography, two were associated with cerebral infarction. Logistic regression analysis showed that a new postoperative neurological deficit predicted an unforeseen vessel occlusion on postoperative angiography. Factors could not be identified that predicted unexpected residual aneurysm or unclipped aneurysm. The inability to predict accurately the presence of residual or unclipped aneurysm suggests that all patients should undergo postoperative angiography. Since a new postoperative neurological deficit is one factor predicting unexpected arterial occlusion, intraoperative angiography may be necessary to help reduce the incidence of stroke after aneurysm surgery. With study of more patients or of factors not examined in this series, it may be possible to select cases more accurately for intraoperative or postoperative angiography.
Authors:
R L Macdonald; M C Wallace; J R Kestle
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  79     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  1993 Dec 
Date Detail:
Created Date:  1993-12-27     Completed Date:  1993-12-27     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  826-32     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of Toronto, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adult
Arterial Occlusive Diseases / etiology,  radiography*
Cerebral Angiography*
Cerebral Infarction / etiology
Contrast Media
Craniotomy
Female
Humans
Intracranial Aneurysm / radiography*,  surgery*
Intraoperative Complications / radiography*
Male
Middle Aged
Postoperative Complications / radiography*
Predictive Value of Tests
Treatment Outcome
Chemical
Reg. No./Substance:
0/Contrast Media
Comments/Corrections
Comment In:
J Neurosurg. 1994 Aug;81(2):335-6   [PMID:  8027827 ]
J Neurosurg. 1995 Jan;82(1):148   [PMID:  7880271 ]
J Neurosurg. 1994 May;80(5):953-4   [PMID:  8169647 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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