CT Angiography Alone Can Provide Sufficient Angio-Architectual Information About Unruptured Intracranial Aneurysms to Proceed Straight to Treatment (P1.145)

Background: The prevalence of intracranial aneurysms is estimated to be between 0.2 and 9.9% for the general population, with an average annual rupture rate of up to 1.3%. Unruptured intracranial aneurysms (UIA) pose a dilemma to clinicians attempting to ascertain the risk of rupture and balance that with treatment associated complications. Traditionally digital subtraction angiography (DSA) has been used as the gold standard for treatment planning. Evolving CT angiography (CTA) technology has resulted in a paradigm shift towards using CTA as the sole modality for pre-treatment decision making. Method: We retrospectively analyzed 29 consecutive patients with UIA who underwent either endovascular coiling or neurosurgical clipping at our institution from January 2013 to July 2013. All patients had unruptured aneurysms imaged on CTA. Results: For 22 patients (76%) the CTA alone was deemed sufficient to proceed straight to treatment, while for 7 patients (24%), DSA was considered necessary for treatment planning. Of the 22 patients who went straight to treatment, 19 were successfully treated (17 patients had endovascular coiling and 2 patients underwent surgical clipping). 3 patients (10%) in the straight to treatment group failed an attempt at endovascular coiling due to unfavorable anatomy. These patients required neurosurgical clipping. Conclusion: 76% of our patients did not undergo DSA prior to treatment. Information provided by CTA was sufficient to treat 19 of the 22 patients (86%). The use of routine DSA for the pre-treatment planning of unruptured intracranial aneurysms may warrant reconsideration in centers with experience in neurovascular CTA. Disclosure: Dr. Ben-Israel has nothing to disclose. Dr. Turkel-Parrella has nothing to disclose. Dr. Kouzmina has nothing to disclose. Dr. Marotta has received royalty, license fee, or contractual payments as co-inventor of Eclips. Dr. Spears has nothing to disclose. Dr. de Oliveira Manoel has nothing to disclose.