Application of three-dimensional digital subtraction angiography in the evaluation of ruptured intracranial aneurysm after clipping

Objective To assess the application of three-dimensional digital subtraction angiography(3DDSA) in evaluation of ruptured intracranial aneurysm after clipping and to discuss the different variable use of volume rendering(VR), gradient rendering(GR) and maximum intensity projection(MIP). Methods From January 2011 to December 2012, 88 patients with 92 ruptured intracranial aneurysms were treated with clipping using titanium clips in our hospital and followed up by both 2D-DSA and 3D-DSA. Residual aneurysms, Clips place, clips and parent arteries and stenosis of parent arteries were evaluated by volume rendering(VR), gradient rendering(GR) and maximum intensity projection(MIP). Results Among 92 clipped aneurysms, 23 residual aneurysms were found by 3D-DSA. Residual aneurysms were recorded according to the Sindou grade : 15 of gradeⅠ, 3 of grade Ⅱ, 4 of grade Ⅲ and 1 of grade Ⅳ. Three patients of grade Ⅲ and 1 of grade Ⅳwith residual aneurysms were retreated by clipping or coiling, and 1 patient of grade Ⅲ was dead with rupture of residual aneurysm. The clips and number of clips were clearly visualized, and relationship between the clips and the aneurysms was well demonstrated by VR, GR and MIP images. VR, GR images showed the remnants clearly. Three-dimensional digital subtraction angiography did not showed accurate details of the stenosis of parent arties which required an analysis of 2D-DSA. Conclusion Three-dimensional digital subtraction angiography can be used for definite evaluation of residual aneurysms after clipping, especially by VR, GR images. It is helpful to manage the residual ruptured aneurysms.