Can Aneurysms Be Treated During the Same Angiogram Session?
Yes, intracranial aneurysms can absolutely be treated during the same digital subtraction angiography (DSA) session through endovascular coiling or other interventional techniques. This is standard practice in modern neurovascular care, where diagnostic angiography seamlessly transitions to therapeutic intervention when appropriate.
How This Works in Practice
Diagnostic to Therapeutic Transition
DSA serves dual purposes: It is both the gold standard for diagnosing and characterizing aneurysms AND the platform through which endovascular treatment is delivered 1.
3D rotational angiography during DSA provides detailed anatomic information about the aneurysm's size, neck configuration, relationship to parent vessels, and branch vessel anatomy—all critical for determining if immediate endovascular treatment is feasible 1, 2.
The combination of 2D and 3D cerebral angiography provides the best morphological depiction with high spatial resolution, which is essential for endovascular therapy planning 2.
When Same-Session Treatment Occurs
Ruptured aneurysms are the most common scenario for immediate treatment:
In acute subarachnoid hemorrhage, once DSA identifies the ruptured aneurysm, endovascular coiling can be performed immediately during the same procedure to secure the aneurysm and prevent rebleeding 3.
The aneurysm should be secured urgently (ideally within 24-48 hours), and for most patients eligible for both approaches, endovascular coiling is preferred based on better long-term outcomes 3.
Studies show that 61.4% of patients with subarachnoid hemorrhage were referred to endovascular treatment based on pre-procedure imaging, with successful coiling achieved in 92.6% 1.
Unruptured aneurysms may also be treated during the diagnostic angiogram if:
- The patient has been counseled and consented for potential treatment
- The aneurysm anatomy is favorable for endovascular approach
- The interventional team is prepared for therapeutic intervention
Important Caveats
Not All Aneurysms Can Be Treated This Way
Aneurysm location and complexity matter: Posterior communicating artery (62%) and posterior circulation aneurysms (67-75%) more commonly require additional imaging or surgical planning compared to middle cerebral artery aneurysms (34%) 4.
Complex aneurysms (giant >25mm, presence of daughter sacs, fusiform/dissecting morphology, or arteries supplying normal brain coming off the aneurysm) may require more detailed pre-treatment planning and may not be suitable for same-session treatment 1.
Pre-Procedure Planning
While CTA can detect aneurysms with >90% sensitivity for most lesions, CTA has limitations in detecting aneurysms <3mm and in providing complete characterization of aneurysm neck and relationship to parent vessels 3.
DSA remains superior because it provides the most detailed information for determining the optimal treatment approach, and 3D rotational angiography identifies aneurysms in 25% of patients with previously negative 2D angiograms 3.
Surgical Clipping Alternative
Some aneurysms are better suited for microsurgical clipping rather than endovascular treatment, particularly those with wide necks, branch vessels arising from the aneurysm, or certain anatomic configurations 1.
In these cases, the diagnostic angiogram provides the roadmap for subsequent surgical intervention rather than immediate endovascular treatment.
Clinical Bottom Line
The modern approach to aneurysm management frequently involves diagnostic DSA with immediate transition to endovascular coiling in the same session, particularly for ruptured aneurysms requiring urgent treatment 3. The interventional neuroradiologist can assess the aneurysm in real-time with 3D rotational angiography and proceed directly to coiling if the anatomy is favorable 2, 5. This "one-stop-shop" approach minimizes delays in treatment, reduces the need for multiple procedures, and is now the standard of care for many intracranial aneurysms amenable to endovascular therapy 1, 3.