뇌동맥류 수술 후 뇌혈관 조영술의 임상적 의의

Abstract

OBJECTIVE: To identify the clinical significance of routine postoperative angiography, the incidence of residual aneurysms after clipping and the risk factors related to the occurrence of residual aneurysm are investigated. METHODS: Of 255 patients who underwent aneurysm clipping between 1999 and 2002, ninety one patients underwent routine angiography after aneurysm clipping by one surgeon. There were 104 aneurysms in these 91 patients. Postoperative angiography were reviewed. RESULTS: Of the 104 aneurysms, 9 (8.7%) had aneurysmal remnant on postoperative angiography. Incomplete clipping was intentionally performed in 4 aneurysms more than 10mm in size and in one basilar tip aneurysm. The remaining 4 aneurysms had unexpected remnant of sac, which was anterior choroidal artery aneurysm in 1 and anterior communicating artery aneurysms projecting superiorly or posterior-superiorly in 3. Thus, the true incidence of residual aneurysm was 3.8% (4/104 aneurysms). Logistic regression analysis showed the size of aneurysm as the only risk factor of residual aneurysm. Occlusion or narrowing of major artery was noted in 4.8%. Even though we had re-adjusted the clip in two cases because of parent arterial narrowing on postoperative angiography, two patients died due to cerebral infarction. CONCLUSION: Routine postoperative angiography has little clinical significance in view of the incidence and management of the residual aneurysm or major arterial narrowing/occlusion. Postoperative angiography seems to be necessary in limited patients after aneurysm surgery.