Introduction. 3D Rotational Angiography (RA) is indispensable for evaluation of intracranial aneurysms, providing infinite viewing angles and defining the aneurysm morphology. Its role in follow-up of clipped aneurysms remains unclear. We aimed to compare the aneurysm residue/recurrence detection rate of 3D RA with 2D digital subtraction angiography (DSA). Methods. 47 patients harboring 54 clipped aneurysms underwent both 2D DSA and 3D RA. The residual/recurrent aneurysms were classified into five grades and the images of both modalities were compared. Results. The residual/recurrent aneurysm detection rate was 53.70% (29/54 aneurysms) with 2D DSA and 66.67% (36/54 aneurysms) with 3D RA ( ). In 12 aneurysms, 3D RA upgraded the residue/recurrence among which nine had been completely not detected on 2D DSA and were found to have grade one or two residual necks on the 3D RA, and, in three cases, a small neck on 2D DSA turned out to be aneurysm sac on 3D RA. In a total of 5 aneurysms, the classification was downgraded by 3D RA. Conclusion. 3D RA picks up more aneurysm residue/recurrence; hence, both 2D DSA and 3D RA should be performed in follow-up evaluation of clipped aneurysms. 1. Introduction X-ray digital subtraction angiography (DSA) has been the gold standard investigation in the evaluation of intracranial aneurysms both before and after surgical clipping [1–3]. Two-dimensional (2D) DSA has been used over the years and has been supplemented by three-dimensional (3D) Rotational Angiography (RA) which has been shown to be superior in evaluation of untreated aneurysms with regard to aneurysm detection rate, morphology delineation, and size estimation, features which have a direct implication in the treatment planning. Thus, now 3D RA is being labelled as the “new gold standard” [4–9]. Considering the added advantage of 3D RA over 2D DSA in evaluation of native aneurysms, it follows that the same could also be applicable to evaluation of clipped aneurysms. We undertook the study to assess whether 3D RA compared favourably to 2D DSA in picking up aneurysm remnant/recurrence. 2. Materials and Methods 47 consecutive patients referred to the authors for follow up angiograms after surgical clipping were taken into study and underwent both 2D DSA and 3D RA on a Neurostar Biplane Neuroangiography suite (Siemens, Erlangen, Germany). The 2D views taken were anteroposterior (AP), lateral (Lat), and right and left anterior obliques (RAO, LAO) and a view with specific angle determined by preoperative DSA showing the neck of the aneurysm. 3D RA was subsequently
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