OBJECTIVES

: Digital subtraction angiography (DSA) has been used as the gold standard to confirm successful aneurysmal obliteration after aneurysm clipping procedures using titanium or cobalt alloy clips. Computed tomographic angiography (CTA) is a newer, less invasive imaging technique also used to confirm successful aneurysmal obliteration; however, its use compared to DSA remains controversial.

METHODS

: A comprehensive literature search was conducted on Pubmed, EMBASE and Cochrane databases through November 6th, 2017 for studies that evaluated post-clipping aneurysm obliteration with both CTA and DSA. Pooled sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were calculated using the bivariate random-effects model.

RESULTS

: Out of 6,916 studies, 13 studies met inclusion criteria for this meta-analysis. A total of 510 patients with 613 aneurysms were included. Compared to DSA, which detected 87 residual aneurysms, CTA detected 58 resulting in a pooled sensitivity of 69% (95% CI: 54%, 81%) and a pooled specificity of 99% (95% CI: 97%, 99%). This corresponded to LR+ of 55.5 (95%CI: 23.6, 130.9) and LR- of 0.31 (95%CI: 0.20, 0.48). Univariate meta-regression revealed that the pooled sensitivity was worse in prospective designs (P-interaction<0.05) and the pooled specificity was better in higher quality studies and for post-operative aneurysm diameters of <2 mm (p-interaction<0.001 for both).

CONCLUSIONS

: This meta-analysis revealed that CTA had a favorable LR+, but not favorable LR-. Thus, this imaging modality may be applicable to rule in, but not rule out, residual aneurysms after clipping.