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Postop Evaluation of Aneurysms (Including Vasospasm)

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Neurovascular Imaging

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Abstract

Both endovascular and microsurgical approaches are used to treat cerebral aneurysms. Endovascular techniques include coil embolization, stenting, or a combination of these. Microsurgical procedures include clipping, without or with vessel bypass. Radiological imaging, particularly with digital subtraction angiography, CTA, and MRA, plays a critical role in the posttreatment assessment of patient with cerebral aneurysms. The indications for various imaging modalities after treatment of cerebral aneurysms, potential artifacts related to imaging, and strategies to mitigate these, expected imaging findings following treatment, as well as the imaging findings for associated complications are discussed and illustrated in this chapter.

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References

  1. Bederson JB, Connolly ES Jr, Batjer HH et al (2009) American Heart Association. Guidelines for the management of aneurismal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 40(3):994–1025

    Article  PubMed  Google Scholar 

  2. Molyneux AJ, Kerr RSC, Yu L-M, Clarke M, Sneade M, Yarnold JA et al (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366(9488):809–817

    Article  PubMed  Google Scholar 

  3. Ginat DT, Smith ER, Robertson RL, Scott RM, Schaefer PW (2013) Imaging after direct and indirect extracranial bypass surgery. AJR Am J Roentgenol 201(1):W124–W132

    Article  PubMed  Google Scholar 

  4. Deutschmann HA, Wehrschuetz M, Augustin M, Niederkorn K, Klein GE (2012) Long-term follow-up after treatment of intracranial aneurysms with the Pipeline embolization device: results from a single center. AJNR Am J Neuroradiol 33(3):481–486. doi:10.3174/ajnr.A2790

    Article  CAS  PubMed  Google Scholar 

  5. Tsutsumi K, Ueki K, Morita A, Usui M, Kirino T (2001) Risk of aneurysm recurrence in patients with clipped cerebral aneurysms: results of long-term follow-up angiography. Stroke 32(5):1191–1194

    Article  CAS  PubMed  Google Scholar 

  6. David CA, Vishteh AG, Spetzler RF, Lemole M, Lawton MT, Partovi S (1999) Late angiographic follow-up review of surgically treated aneurysms. J Neurosurg 91(3):396–401

    Article  CAS  PubMed  Google Scholar 

  7. Wallace RC, Karis JP, Partovi S et al (2007) Noninvasive imaging of treated cerebral aneurysms. Part I. MR angiographic follow-up of coiled aneurysms. AJNR Am J Neuroradiol 28:1001–1008

    Article  CAS  PubMed  Google Scholar 

  8. Shinohara Y, Sakamoto M, Iwata N, Kishimoto J, Kuya K, Fujii S, Kaminou T, Watanabe T, Ogawa T (2014) Usefulness of monochromatic imaging with metal artifact reduction software for computed tomography angiography after intracranial aneurysm coil embolization. Acta Radiol 55:1015–1023. doi:10.1177/028418511351049

    Article  PubMed  Google Scholar 

  9. Phan CM, Yoo AJ, Hirsch JA et al (2012) Differentiation of hemorrhage from iodinated contrast in different intracranial compartments using dual-energy head CT. AJNR Am J Neuroradiol 33:1088–1094

    Article  CAS  PubMed  Google Scholar 

  10. Kaufmanna TJ, Huston J III, Cloft HJ, Mandrekar J, Gray L, Bernstein MA, Atkinson JL, Kallmes DF (2010) A prospective trial of 3T and 1.5T time-of-flight and contrast-enhanced MR angiography in the follow-up of coiled intracranial aneurysms. AJNR 31:912–918

    Article  Google Scholar 

  11. Olsen RV, Munk PL, Lee MJ et al (2000) Metal artifact reduction sequence: early clinical applications. Radiographics 20(3):699–712

    Article  CAS  PubMed  Google Scholar 

  12. Walker MT, Tsai J, Parish T et al (2005) MR angiographic evaluation of platinum coil packs at 1.5T and 3T: an in vitro assessment of artifact production: technical note. Am J Neuroradiol 26:848–853

    PubMed  Google Scholar 

  13. Gonner F, Heid O, Remonda L, et al. (1998) MR angiography with ultrashort echo time in cerebral aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol 19:1324–1328

    CAS  PubMed  Google Scholar 

  14. Kaufmann TJ, Huston J III, Cloft HJ et al (2010) A prospective trial of 3T and 1.5T time-of-flight and contrast-enhanced MR angiography in the follow-up of coiled intracranial aneurysms. Am J Neuroradiol 31:912–918

    Article  CAS  PubMed  Google Scholar 

  15. Leffers AM, Wagner A (2000) Neurologic complications of cerebral angiography. A retrospective study of complication rate and patient risk factors. Acta Radiol 41:204–210

    Article  CAS  PubMed  Google Scholar 

  16. Cloft HJ, Joseph GJ, Dion JE (1999) Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation. A meta-analysis. Stroke 30(2):317–320

    Article  CAS  PubMed  Google Scholar 

  17. Hanley M, Zenzen WJ, Brown MD, Gaughen JR, EvansHanley AJ et al (2008) Comparing the accuracy of digital subtraction angiography, CT angiography and MR angiography at estimating the volume of cerebral aneurysms. Interv Neuroradiol 14(2):173–177

    PubMed Central  CAS  PubMed  Google Scholar 

  18. Kassell N, Sasaki T, Colohan A, Nazar G (1985) Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke 16(4):562–572

    Article  CAS  PubMed  Google Scholar 

  19. Dankbaar JW, Slooter A, Rinkel G, Schaaf IC (2010) Effect of different components of triple-H therapy on cerebral perfusion in patients with aneurysmal subarachnoid hemorrhage: a systematic review. Crit Care 14(1):R23

    Article  PubMed Central  PubMed  Google Scholar 

  20. Wilson DA, Nakaji P, Abla AA, Uschold TD, Fusco DJ, Oppenlander ME et al (2012) A simple and quantitative method to predict symptomatic vasospasm after subarachnoid hemorrhage based on computed tomography: beyond the Fisher scale. Neurosurgery 71(4):869–875

    Article  PubMed  Google Scholar 

  21. Aaslid R, Markwalder T-M, Nornes H (1982) Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 57(6):769–774

    Article  CAS  PubMed  Google Scholar 

  22. Lindegaard K-F, Nornes H, Bakke SJ, Sorteberg W, Nakstad P (1988) Cerebral vasospasm after subarachnoid hemorrhage investigated by means of transcranial Doppler ultrasound. In: Proceedings of the 8th European Congress of Neurosurgery, 6–11 September 1987. Springer, Barcelona

    Google Scholar 

  23. Lysakowski C, Walder B, Costanza MC, Tramèr MR (2001) Transcranial Doppler versus angiography in patients with vasospasm due to a ruptured cerebral aneurysm a systematic review. Stroke 32(10):2292–2298

    Article  CAS  PubMed  Google Scholar 

  24. Anderson GB, Ashforth R, Steinke DE, Findlay JM (2000) CT angiography for the detection of cerebral vasospasm in patients with acute subarachnoid hemorrhage. Am J Neuroradiol 21(6):1011–1015

    CAS  PubMed  Google Scholar 

  25. Chappell ET, Moure FC, Good MC (2003) Comparison of computed tomographic angiography with digital subtraction angiography in the diagnosis of cerebral aneurysms: a meta-analysis. Neurosurgery 52(3):624–631

    Article  PubMed  Google Scholar 

  26. van Rooij WJ, Sluzewski M, Beute GN, Nijssen PC (2006) Procedural complications of coiling of ruptured intracranial aneurysms: incidence and risk factors in a consecutive series of 681 patients. Am J Neuroradiol 27:1498–1501

    PubMed  Google Scholar 

  27. Sluzewski M, van Rooij WJ (2005) Early rebleeding after coiling of ruptured cerebral aneurysms: incidence, morbidity, and risk factors. Am J Neuroradiol 26:1739–1743

    PubMed  Google Scholar 

  28. Johnston SC, Dowd CF, Higashida RT, Lawton MT, Duckwiler GR, Gress DR, CARAT Investigators (2008) Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the Cerebral Aneurysm Rerupture After Treatment (CARAT) study. Stroke 39(1):120–125

    Article  PubMed  Google Scholar 

  29. Naggara ON, White PM, Guilbert F et al (2010) Endovascular treatment of intracranial unruptured aneurysms: systematic review and meta-analysis of the literature on safety and efficacy. Radiology 256:887–897

    Article  PubMed  Google Scholar 

  30. Rordorf G, Bellon RJ, Budzik RE Jr et al (2001) Silent thromboembolic events associated with the treatment of unruptured cerebral aneurysms by use of Guglielmi detachable coils: prospective study applying diffusion-weighted imaging. Am J Neuroradiol 22:5–10

    CAS  PubMed  Google Scholar 

  31. Kang D-H et al (2013) MR-DWI–positive lesions and symptomatic ischemic complications after coiling of unruptured intracranial aneurysms. Stroke 44:789–791

    Article  PubMed  Google Scholar 

  32. Altay T, Kang HI, Woo HH et al (2011) Thromboembolic events associated with endovascular treatment of cerebral aneurysms. J Neurointerv Surg 3:147–150

    Article  PubMed  Google Scholar 

  33. Hahnemann ML, Ringelstein A, Sandalcioglu IE, Goericke S, Moenninghoff C, Wanke I, Forsting M, Sure U, Schlamann M (2014) Silent embolism after stent-assisted coiling of cerebral aneurysms: diffusion-weighted MRI study of 75 cases. J Neurointerv Surg 6:461–465

    Article  CAS  PubMed  Google Scholar 

  34. Mocco J, Fargen KM, Albuquerque FC, Bendok BR et al (2011) Delayed thrombosis or stenosis following enterprise-assisted stent-coiling: is it safe? Midterm results of the interstate collaboration of enterprise stent coiling. Neurosurgery 69(4):908–914

    Article  CAS  PubMed  Google Scholar 

  35. Albuquerque FC, Levy EI, Turk AS, Niemann DB, Aagaard-Kienitz B, Pride GL Jr et al (2008) Angiographic patterns of Wingspan in-stent restenosis. Neurosurgery 63(1):23–27

    Article  PubMed  Google Scholar 

  36. Song JK, Niimi Y, Fernandez PM, Brisman JL, Buciuc R, Kupersmith MJ, Berenstein A (2004) Thrombus formation during intracranial aneurysm coil placement: treatment with intra-arterial abciximab. Am J Neuroradiol 25:1147–1153

    PubMed  Google Scholar 

  37. Derdeyn CP, Cross DT III, Moran CJ, Brown GW et al (2002) Postprocedure ischemic events after treatment of intracranial aneurysms with Guglielmi detachable coils. J Neurosurg 96(5):837–843

    Article  PubMed  Google Scholar 

  38. Cognard C, Weill A, Castaings L et al (1998) Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology 206:499–5108

    Article  CAS  PubMed  Google Scholar 

  39. Kanaan H, Jankowitz B, Akeu A, Kostov D et al (2010) In-stent thrombosis and stenosis after neck-remodeling device-assisted coil embolization of intracranial aneurysms. Neurosurgery 67(6):1523–1533

    Article  PubMed  Google Scholar 

  40. McLaughlin N, McArthur D, Martin D (2013) Use of stent-assisted coil embolization for the treatment of wide-necked aneurysms: a systematic review. Surg Neurol Int 4:43

    Article  PubMed Central  PubMed  Google Scholar 

  41. Fiorella D, Kelly ME, Moskowitz S, Masaryk TJ (2009) Delayed symptomatic coil migration after initially successful balloon-assisted aneurysm coiling: technical case report. Neurosurgery 64(2):E391–E392; discussion E392

    Article  PubMed  Google Scholar 

  42. Bhatti MT, Peters KR, Firment C, Mericle RA (2004) Delayed exacerbation of third nerve palsy due to aneurysmal regrowth after endovascular coil embolization. J Neuroophthalmol 24(1):3–10

    Article  PubMed  Google Scholar 

  43. Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J et al (2003) Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg 98(5):959–966

    Article  PubMed  Google Scholar 

  44. Ferns SP, Sprengers ME, van Rooij WJ et al (2009) Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates. Stroke 40:e523–e529

    Article  PubMed  Google Scholar 

  45. Cognard C, Weill A, Spelle L et al (1999) Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 212:348–356

    Article  CAS  PubMed  Google Scholar 

  46. van Rooij WJ, Sluzewski M (2009) Opinion: imaging follow-up after coiling of intracranial aneurysms. Am J Neuroradiol 30:1646–1648

    Article  PubMed  Google Scholar 

  47. Sluzewski M, van Rooij WJ, Rinkel GJ et al (2003) Endovascular treatment of ruptured intracranial aneurysms with detachable coils: long-term clinical and serial angiographic results. Radiology 227:720–724

    Article  PubMed  Google Scholar 

  48. Sprengers ME, Schaafsma J, van Rooij WJ et al (2008) Stability of intracranial aneurysms adequately occluded 6 months after coiling: a 3T MR angiography multicenter long-term follow-up study. Am J Neuroradiol 29(9):1768–1774

    Article  CAS  PubMed  Google Scholar 

  49. Schaafsma JD, Sprengers ME, van Rooij WJ et al (2009) Long-term recurrent subarachnoid hemorrhage after adequate coiling versus clipping of ruptured intracranial aneurysms. Stroke 40:1758–6

    Article  PubMed  Google Scholar 

  50. McLaughlin N, Bojanowski MW (2004) Early surgery-related complications after aneurysm clip placement: an analysis of causes and patient outcomes. J Neurosurg 101(4):600–606

    Article  PubMed  Google Scholar 

  51. Sprengers ME, van Rooij WJ, Sluzewski M, Rinkel GJ, Velthuis BK, de Kort GA, Majoie CB (2009) MR angiography follow-up 5 years after coiling: frequency of new aneurysms and enlargement of untreated aneurysms. AJNR Am J Neuroradiol 30(2):303–307

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, University of Chicago, A27 S Maryland Ave, Chicago, IL, 60637, USA

    Michael Mayich

  2. Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA

    Brian P. Walcott & Christopher J. Stapleton

  3. Department of Radiology, University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA

    Daniel Thomas Ginat

Authors
  1. Michael Mayich
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  2. Brian P. Walcott
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  3. Christopher J. Stapleton
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  4. Daniel Thomas Ginat
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Correspondence to Daniel Thomas Ginat .

Editor information

Editors and Affiliations

  1. Department of Radiology, AOU of Cagliari, Monserrato, Cagliari, Italy

    Luca Saba

  2. Neurointerventional Radiology Section, Department of Radiology, NYU Langone Medical Center, New York, NY, USA

    Eytan Raz

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Mayich, M., Walcott, B.P., Stapleton, C.J., Ginat, D.T. (2016). Postop Evaluation of Aneurysms (Including Vasospasm). In: Saba, L., Raz, E. (eds) Neurovascular Imaging. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9029-6_44

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  • DOI: https://doi.org/10.1007/978-1-4614-9029-6_44

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