Oper Neurosurg. 2026 Apr 20. doi: 10.1227/ons.0000000000002018. Online ahead of print.
ABSTRACT
BACKGROUND AND OBJECTIVES: Arterial angiography remains the gold standard for the assessment of cerebrovascular anatomy and pathology. However, when arterial access is higher risk (patients with extreme tortuosity, type 4 Ehlers Danlos Syndrome, or the young pediatric population), and for long-term follow-up or intraoperative scenarios, intravenous 3-dimensional digital subtraction angiography (IV 3D-DSA) is an acceptable substitute. We assessed our experience in consecutive IV 3D-DSA procedures.
METHODS: Five hundred twenty-eight adult and 21 pediatric IV 3D-DSAs were performed at our institution on 2 state-of-the-art systems from January 2019 to March 2025. Imaging obtained on older angiography systems are not included. The cone-beam computed tomography (CBCT) data were reconstructed and displayed as 3D-DSA, CBCT without contrast, and CBCT angiography. Data were analyzed for indication, conversion to intra-arterial angiography, use of anesthesia, radiation dose, and complications.
RESULTS: The primary indication in 408/528 adult and 9/21 pediatric patients was aneurysm evaluation, initial, postoperative, or follow-up. Other indications included vascular malformations, postoperative after revascularization surgeries, and other pathologies such as extracranial carotid disease and intracranial atherosclerotic disease. Seven of the 528 adult cases were significantly limited by motion artifact (1.3%), but only 3 of these were considered nondiagnostic (0.6%). Seventy-one adult and 2 pediatric acquisitions were performed intraoperatively in the hybrid operating room. 20/21 pediatric cases required general anesthesia. Eighty-six adult cases were performed under anesthesia, although most of these were performed intraoperatively under the same anesthetic as the index operation. There were no significant complications reported.
CONCLUSION: With the newer, higher resolution, semirobotic biplane systems, IV 3D-DSA has become a tool in the angiography suite for rapid vascular assessment. It offers increased spatial resolution when compared with multidetector computed tomography, making it well suited to evaluate vasculature and endovascular devices, is noninvasive compared with catheter angiography, and can be used for intraoperative assessment of treatment.
PMID:42007768 | DOI:10.1227/ons.0000000000002018
