1057. Comparison of intra- and postoperative three-dimensional digital subtraction angiography in evaluation of the surgical result after intracranial aneurysm treatment.

Authors: Javier Fandino, MD, IFAANS; Serge Marbacher, MD, PhD; Jenny Kienzler, MD; Itai Mendelowitsch, MD; Donato D'Alonzo, MD; Michael Diepers, MD; Luca Remonda, MD; Javier Fandino, MD; Lukas Andereggen, MD (Aarau, Switzerland)

Introduction: Postoperative three-dimensional digital subtraction angiography (3D-pDSA) has become the gold standard in detecting and evaluating intracranial aneurysm (IA) remnants after clipping. Should intraoperative 3D-DSA (3D-iDSA) image quality be equally good as 3D-pDSA it could supplant 3D-pDSA as quality control and standard of care in follow-up of clipped IA. We directly evaluate and compare the quality of assessment of clipped IA in 3D-iDSA and 3D-pDSA. Methods: In our retrospective analysis of prospectively collected data, 221 consecutive patients underwent craniotomy of intracranial aneurysms (IAs) in a hybrid operating room. The clipped IA complex visualized in intra- and postoperative 3D-DSA images of each patient were blinded and rated by two reviewers. Variables analyzed included patient demographics, IA specific characteristics, and 3D-iDSA and 3D-pDSA findings. We evaluated parameters influencing overall image quality and analyzed the discordance rate between the two modalities. Results: A total of 26 patients underwent both 3D-iDSA and 3D-pDSA to evaluate 32 clipped IA. The mean time interval between the examinations was 11 ± 7 months . Multiple clip reconstruction was necessary in 44 % of cases (14/32). Most aneurysm remnants were small (60% < 2mm; 9/15). There were no discordances in assessment of the surgical result in any of the clipped IA between 3D-iDSA and 3D-pDSA. Excellent overall imaging quality was found for both modalities. Influencing factors for minor differences in image quality between 3D-iDSA and 3D-pDSA could not be determined. Conclusion: 3D-iDSA demonstrates equal high image quality when compared with 3D-pDSA imaging and allows for excellent immediate interpretation of the surgical result after clipping. With equal imaging quality and no discordant findings between 3D-iDSA and 3D-pDSA, 3D-iDSA can substitute pDSA and may become standard of care in IA surgery.