What is the role of angiography in the workup of cerebral aneurysms?

Updated: Dec 06, 2018
  • Author: David S Liebeskind, MD, FAAN, FAHA, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Conventional angiography is the definitive procedure for the detection and characterization of cerebral aneurysms. Aneurysm location, size, and morphology may be evaluated in the acute or chronic setting with this modality.

Digital subtraction angiography with biplanar magnification views provides details that may be helpful in identifying an acutely ruptured aneurysm.

Aneurysmal irregularity, the presence of a daughter loculus, or focal spasm may be noted with acute rupture. Vasospasm may be depicted reliably and the collateral circulation may be demonstrated.

Perform 4-vessel angiography to identify remote vasospasm and the presence of multiple aneurysms. Acute angiography occasionally yields negative results (eg, due to thrombosis or vasospasm), in which case angiography should be repeated 1-3 weeks later. However, the risk and expense of this procedure may not be appropriate for screening of high-risk individuals.

A junctional dilatation of the terminal carotid artery at the origin of the PCoA may be noted in about 5-10% of patients. These infundibula or conical enlargements of less than 3 mm are unlikely to enlarge or rupture. However, overt aneurysms at the juncture of the terminal carotid artery with a persistent PCoA configuration may be more prone to rupture.

Further refinements in the characterization of cerebral aneurysms are expected following the recent introduction of 3-dimensional rotational angiography. Recent work has demonstrated that this technique may offer superior resolution and increased sensitivity for detection of small aneurysms. [8]

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