RISKS AND BENEFITS OF DIAGNOSTIC ANGIOGRAPHY AFTER ANEURYSM SURGERY -A RETROSPECTIVE ANALYSIS OF 597 STUDIES

INTRODUCTION: Cerebral angiography performed after aneurysm surgery ca n identify causes of morbidity and mortality that may be corrected. Th e risks and benefits of angiography that is performed after aneurysm s urgery, however, have not been clearly defined. We therefore reviewed our experience with postoperative angiography to determine its dangers and benefits. METHODS: During 10 years, 543 consecutive patients rece ived treatment for cerebral aneurysms. A retrospective analysis of 597 diagnostic angiograms obtained after aneurysm surgery for 494 of thes e patients was performed. RESULTS: Catheter-induced vessel spasm and d issection, occurring most frequently in the internal carotid artery, w ere observed in seven (1.2%) and six (1%) studies, respectively. No an giography-associated strokes were identified. No association between a ge, smoking, hypertension, blood pressure, atherosclerosis, or severe vasospasm and angiographic complications was observed. Aneurysm remnan ts were identified in 36 (5.7%) of the 637 aneurysms that were surgica lly treated. Atherosclerosis (P < 0.01) or multiple clip applications (P < 0.01) were significantly associated with aneurysm remnants. Angio graphic vessel occlusion was observed in 28 (5.7%) patients and result ed in stroke in 14 of these patients. Vessel occlusion was significant ly associated with increasing aneurysm size (P < 0.001), atheroscleros is (P < 0.001), temporary clips (P < 0.001), multiple clips (P = 0.03) , multiple clip applications (P = 0.001), and a new postoperative neur ological deficit (P = 0.002). Severe vasospasm and newly identified an eurysms were observed in 51 and 16 patients, respectively. CONCLUSION: Angiography after aneurysm surgery is safe and can be routinely perfo rmed. Angiography after aneurysm surgery should be particularly consid ered for patients with large aneurysms or cerebrovascular atherosclero sis and for those who develop new postoperative neurological deficits.