Publication: Comparison of immediate post-operative ct angiography with delayed angiography to detect aneurysm remnant: A cross-sectional study in HSAJB
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Date
2020
Authors
Sridharan, Saravanan
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Abstract
Background and Objective Ruptured intracranial aneurysm is a common cause of stroke leading to high morbidity and mortality. Despite there are advancements in the surgical management of ruptured aneurysms, post-operative follow-up imaging still varies, and no consensus. Currently, some centers are utilising an immediate post-operative CT scan to detect residual aneurysm. Hence, we aim to test the significance and reliability of immediate post-operative CTA. Methods This was a single-center cross-sectional study. A total of 54 patients aged between 18 to 80 years old were admitted to the Department of Neurosurgery, Hospital Sultanah Aminah Johor Bahru (HSAJB) from 1st January 2019 to 31st May 2020 for ruptured aneurysm who fulfilled the inclusion criteria were included in this study. Demographic data including age, gender, type of aneurysm, WFNS score, type of diagnostic imaging, and requirement of EVD were collected. The patients subsequently underwent surgical clipping and subjected to immediate CTA. Then the patients followed up and proceeded with delayed angiography from 3 – 6 months. Data were analysed and the finding of both imaging compared. Results A total of 54 patients with a mean age of 51.87 ± 12.34 years were admitted and subjected to clipping surgery. 66.7% (n=36) admitted with good WFNS score. ACOM aneurysm was the commonest (31.5% (n=17)). Generally, it required a mean time of 4.85days from the day of admission until clipping. Intraoperatively 27.8% (n=15) had re-rupture of the aneurysm. 4 cases (7.4%) were able to detect aneurysm remnants with immediate CTA while 8 cases (14.8%) were detected via delayed angiography. Cohen’s Kappa test showed a value of 0.63, which indicates substantial agreement between immediate and delayed angiography. There is a significant association between intraoperative Doppler signal and detection of vasospasm in CTA (p < 0.001). There is also a significant association between CTA vasospasm and intraoperative rupture (p = 0.006). The general outcome of the patient measured with the mRS score during the 1st follow-up at the mean duration of 53 days was a median of 2. Conclusion There is substantial agreement between immediate CTA and delayed angiography in detecting aneurysm remnants. Therefore using immediate CTA as an early imaging tool post-clipping enables us to tabulate subsequent management strategy. At the same time, if combine with intraoperative Doppler, it can be useful in detecting vasospasm
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Keywords
Aneurysm , Subarachnoid hemorrhage