The Value of CT Angio Brain for Follow up of Clipped Cerebral Aneurysms; The Impact of Aneurysm Clip Material

摘要

The aim of this study was to evaluate the impact of different aneurysm clip materials on the accuracy and image quality of post-operative CT angiography (CTA) emphasizing the completion of aneurysm obliteration. From January 2012 to, Jan 2016; forty-five patients harboring fifty-four cerebral aneurysms with 44 ruptured and 10 unruptured cerebral aneurysms have been treated with open surgical clipping and underwent post-operatively follow up CTA. The results were analyzed regarding the diagnostic yield in view of metallic artifacts with different clip material and at different aneurysm locations. Out of the forty-five cases; 28 patients (62.2%) were treated by titanium aneurysm clips only, three patients (6.7%) with Codman clips only, and nine patients (20 %) with Elgiloy clips (Sugita) only while in five patients (11.1%) different types of clips (mixed) were used. The CTA was informative regarding the target of the study in 37 patients (82.2%) while in eight patients (17.8 %) was none informative either with dense metallic artifacts and/or near the skull base location and so hindering the CTA accuracy in FU of clipped cerebral aneurysms. The Elgiloy and Codman made clips, skull base locations showed less diagnostic yield and even can miss residual aneurysm filling that can be detected only with DSA. Titanium made aneurysm clips showed less metallic artifacts and can increase the diagnostic yield and accuracy of CTA follow up after aneurysm clipping specially when being away from skull base locations.