307 Is Catheter Diagnostic Cerebral Angiography Still Essential for Patients With Spontaneous Perimesencephalic Subarachnoid Hemorrhage and Negative Computed Tomography Angiogram?

Galal, Ahmed; Elserry, Tarek; Aziz, Mohamed Mostafa

doi:10.1227/01.neu.0000489795.44911.e0

Cited by 5 publications

(4 citation statements)

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“…In the literature, the repetition of angiographic studies has reported positive pathologic findings in up to 35% of cases. 26,27 Especially small aneurysms (<4 mm in diameter) and those localized in the posterior circulation are more likely to be missed by CTA. 17,26 For this reason, some authors continue to advocate for DSA studies.…”

Section: Discussionmentioning

confidence: 99%

Non-aneurysmal subarachnoid hemorrhage: When is a second angiography indicated?

et al. 2017

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Purpose Repeat imaging in patients with non-aneurysmal subarachnoid hemorrhage (NASAH) remains controversial. We aim to report our experience with NASAH with different hemorrhage patterns, and to investigate the need for further diagnostic workup to determine the underlying cause of hemorrhage. Method We conducted a retrospective analysis of all spontaneous SAH with an initial negative computed tomography (CT) with angiography (CTA) and/or digital subtraction angiography (DSA) from October 2011 through May 2017. According to the bleeding pattern on the admission CT scan, NASAH was divided into two subgroups: (1) perimesencephalic SAH (PMSAH) and (2) non-perimesencephalic SAH (nPMSAH). Radiological data included the admission CT, CTA, DSA, and magnetic resonance imaging (MRI) with angiography (MRA). Results Seventy-four patients met the inclusion criteria. Thirty-nine (52.7%) patients had PMSAH on the initial CT scan, and 35 (47.3%) had nPMSAH. All underwent CTA and/or DSA revealing no vascular abnormalities. Forty-seven (63.5%) patients underwent subsequent diagnostic workup. DSA was performed in all patients at least once. No abnormalities were found on the repeat DSA or other radiological follow-up studies except in one (1.4%) patient with nPMSAH, in whom a follow-up DSA revealed a small saccular anterior choroidal artery aneurysm, considered to be the source of hemorrhage. Conclusion A repeat DSA may not be needed in case of PMSAH, if the initial negative DSA is technically adequate with absence of hematoma and vasospasm. In contrast, a follow-up DSA should be mandatory for confirming or excluding vascular pathology in case of nPMSAH in order to prevent rebleeding.

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Section: Discussionmentioning

confidence: 99%

Non-aneurysmal subarachnoid hemorrhage: When is a second angiography indicated?

et al. 2017

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“…Non-traumatic SAH is predicted to affect approximately 20,000-30,000 people per year in the United States; of those affected, there is up to a 45% mortality rate within one month [ 1 ]. Computed tomography angiography (CTA) has become a new standard of care in many facilities due to its less invasive nature and high negative predictive value (NPV); furthermore, CTA is even being suggested as the primary means of evaluation and diagnosis in patients presenting with SAH [ 2 - 5 ]. Although this is a useful tool and serves as an effective screening test, it has its limitations.…”

Section: Introductionmentioning

confidence: 99%

The Importance of Catheter Angiography in Computed Tomography Angiography-Negative Subarachnoid Hemorrhage

Haider

Gottlich

Khahera³

et al. 2017

Cureus

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Computed tomography angiography (CTA) has become an effective tool in the evaluation of patients with subarachnoid hemorrhage (SAH), but it still has limitations. Up to 15% of non-traumatic SAH cases are negative on CTA. The benefits of catheter angiography in the evaluation of certain cases of CTA-negative SAH have been previously demonstrated. Here, we present the case of a 48-year-old female who presented with headache and right-sided hemiparesis, who later became apneic and required intubation. A computed tomography (CT) scan of the head demonstrated a diffuse SAH. A CTA of the head and neck showed no vascular abnormality. Catheter angiography diagnosed a conical-shaped aneurysm at the left A1-A2 junction of the anterior communicating artery complex measuring 3.5 mm by 1 mm. The aneurysm was successfully treated with a craniotomy and microvascular clipping using a 4.7 mm curved Yasargil miniclip (Aesculap, Tuttlingen, Germany). This case illustrates the importance and benefit of catheter angiography in CTA-negative cases of SAH.

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“…2,3 In addition, aneurysms with a diameter smaller than 3 mm (so-called “baby” aneurysms) can be missed by CTA examination in up to 9% of cases. 4 In the meta-analysis by Kalra et al., 5 an aneurysm in 8 out of 1031 patients (0.78%) was detected on follow-up imaging. Definition of PMSAH was not consistent throughout the included studies in the meta-analysis.…”

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confidence: 99%

“…Although it is suggested to skip the DSA following a negative CTA, 5 there is still insufficient evidence to suggest that CTA alone is adequate in all centers. 4 Therefore, at least one DSA should be regarded as a gold standard in the case of PMSAH, preferably at the time of admission. A second DSA in such patients, on the other hand, is generally unnecessary, as also recommended by the authors in the meta-analysis.…”

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confidence: 99%