Background: It is unclear whether 16-detector row CT angiography (CTA) can replace digital subtraction angiography (DSA) to assess the feasibility of endovascular treatment (EVT) in the acute phase after aneurysmal subarachnoid hemorrhage. Methods: We studied 80 consecutive patients with aneurysmal subarachnoid hemorrhage, who underwent both CTA and DSA. Two interventional neuroradiologists independently scored CTA and, immediately thereafter, DSA with respect to feasibility of EVT. We determined whether CTA without DSA was sufficient for a definite judgment. We also assessed interobserver agreement. Results: The 2 readers judged EVT to be feasible in 24 and 37 patients with CTA alone and not feasible in 34 and 20 patients. In these patients, DSA yielded additional information in 6 (reader 1) and 5 patients (reader 2), which did not affect treatment decision. In 19 and 7 patients, DSA was considered inferior to CTA. In the remaining patients (n = 22 and 23, respectively), feasibility of EVT could not be judged with CTA alone, and DSA results were required in addition for a treatment decision. Interobserver agreement on feasibility of EVT was just fair (ĸ <0.40). Conclusions: In our series of patients, 16-detector row CTA was a reliable investigation to assess feasibility of EVT of ruptured intracranial aneurysms in most patients. Further, we found that interobserver disagreement on feasibility of EVT was considerable.

Keywords:
Endovascular treatment, Intracranial aneurysm, CT angiography, Subarachnoid hemorrhage
1.
Goddard AJP, Tan G, Becker J: Computed tomography angiography for the detection and characterization of intra-cranial aneurysms: current status. Clin Radiol 2005;60:1221–1236.
2.
Chawla S: Advances in multidetector computed tomography. Applications in neuroradiology. J Comput Assist Tomogr 2004;28:S12–S16.
3.
Wintermark M, Uske A, Chalaron M, Regli L, Maeder P, Meuli R, Schnyder P, Binaghi S: Multislice computerized tomography angiography in the evaluation of intracranial aneurysms: a comparison with intraarterial digital subtraction angiography. J Neurosurg 2003;98:828–836.
4.
Kangasniemi M, Mäkelä T, Koskinen S, Porras M, Poussa K, Hernesniemi J: Detection of intracranial aneurysms with two-dimensional and three-dimensional multislice helical computed tomographic angiography. Neurosurgery 2004;54:336–341.
5.
Dammert S, Krings T, Moller-Hartmann W, Ueffing E, Hans FJ, Willmes K, Mull M, Thron A: Detection of intracranial aneurysms with multislice CT: comparison with conventional angiography. Neuroradiology 2004;46:427–434.
6.
Tipper G, U-King-Im JM, Price SJ, Trivedi RA, Cross JJ, Higgins NJ, Farmer R, Wat J, Kirollos R, Kirkpatrick PJ, Antoun NM, Gillard JH: Detection and evaluation of intracranial aneurysms with 16-row multislice CT angiography. Clin Radiol 2005;60:565–572.
7.
Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group: International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002;360:1267–1274.
8.
Yasargil MG: Microneurosurgery. Stuttgart, Georg Thieme, 1984, vol 1.
9.
Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977;33:159–174.
10.
Missler U, Hundt C, Wiesmann M, Mayer T, Brückmann H: Three-dimensional reconstructed rotational digital subtraction angiography in planning treatment of intracranial aneurysms. Eur Radiol 2000;10:564– 568.
11.
Hochmuth A, Spetzger U, Schumacher M: Comparison of three-dimensional rotational angiography with digital subtraction angiography in the assessment of ruptured cerebral aneurysms. Am J Neuroradiol 2002;23:1199–1205.
12.
Albuquerque FC, Spetzler RF, Zabramski JM, McDougall CG: Effects of three-dimensional angiography on the coiling of cerebral aneurysms. Neurosurgery 2002;51:597–606.
13.
Papke K, Kuhl CK, Fruth M, Haupt C, Schlunz-Hendann M, Sauner D, Fiebich M, Bani A, Brassel F: Intracranial aneurysms: role of multidetector CT angiography in diagnosis and endovascular therapy planning. Radiology 2007;244:532–540.
14.
Dehdashti AR, Rufenacht DA, Delavelle J, Reverdin A, De Tribolet N: Therapeutic decision and management of aneurysmal subarachnoid haemorrhage based on computed tomographic angiography. Br J Neurosurg 2003;17:46–53.
15.
Hoh BL, Cheung AC, Rabinov JD, Pryor JC, Carter BS, Ogilvy CS: Results of a prospective protocol of computed tomographic angiography in place of catheter angiography as the only diagnostic and pretreatment planning study for cerebral aneurysms by a combined neurovascular team. Neurosurgery 2004;54:1329–1342.
16.
Velthuis BK, Van Leeuwen MS, Witkamp TD, Ramos LMP, Berkelbach van der Sprenkel JW, Rinkel GJE: Computerized tomography angiography in patients with subarachnoid hemorrhage: from aneurysm detection to treatment without conventional angiography. J Neurosurg 1999;91:761–767.
17.
Boet R, Poon WS, Lam JMK, Yu SCH: The surgical treatment of intracranial aneurysms based on computer tomographic angiography alone – streamlining the acute management of symptomatic aneurysms. Acta Neurochir 2003;145:101–105.
18.
Cademartiri F, Luccichenti GL, Van der Lugt A, Pavone P, Pattynama PM, de Feyter PJ, Krestin GP: Sixteen-row multislice computed tomography: basic concepts, protocols, and enhanced clinical applications. Semin Ultrasound CT MR 2004;25:2–16.
19.
Velthuis BK, Rinkel GJ, Ramos LM, Witkamp TD, Berkelbach van der Sprenkel JW, Vandertop WP, Van Leeuwen MS: Subarachnoid haemorrhage: aneurysm detection and preoperative evaluation with CT angiography. Radiology 1998;208:423–430.
20.
Kallmes DF, Layton K, Marx WF, Tong F: Death by nondiagnosis: why emergent CT angiography should not be done for patients with subarachnoid hemorrhage. Am J Neuroradiol 2007;28:1837–1838.
© 2008 S. Karger AG, Basel
2008
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.