Safety of intracranial endovascular aneurysm therapy using 3-dimensional rotational angiography: a single-center experience

BACKGROUND: Three-dimensional rotational angiography has recently been implemented in many interventional neuroradiology practices and may assist the endovascular operator in case selection and planning. The end result may be improved safety. METHODS: We retrospectively searched our database for all aneurysms that were treated at our institution since February 1990. We identified 2 groups-those treated before and after the installation of our rotational fluoroscope on April 23, 2003. Patients with extracranial or intracavernous aneurysms were excluded. If multiple treatments were performed, only the first embolizations were considered. We then compared the 2 groups with regard to rates of immediate procedural complications. We further stratified aneurysms by number, size, and neck dimension, and performed subgroup analyses. We also conducted a post hoc comparison between chronological epochs within each group to determine whether improved safety was an epiphenomenon of advances in technology or operator skill. RESULTS: There were a total of 876 patients treated before and 337 after the implementation of 3D-RA (total N = 1213). The overall complication rate in the pre-3D group was 5.9% and 3.0% in the post-3D group (odds ratio, 0.48; 95% CI, 0.24-0.97). Complication rates were also decreased for patients with single aneurysms. Post hoc analysis demonstrated no benefit within chronological subgroups of the pre-3D or post-3D cohorts. This suggests that the improved safety profile after 3D-RA implementation is not an epiphenomenon of factors such as technological advances or experiential improvements in technique. CONCLUSIONS: 3D-RA implemented during endovascular therapy for intracranial aneurysms improves the safety of the procedure. This may be a result of either improved aneurysm analysis and thus case selection, improved working position selection, or both.