3D Rotational Angiography After Non-Traumatic SAH

Abstract

!Purpose: In about 15 % of patients with SAH no causative vascular lesions can be found in acute imaging with CTA and DSA. Usually, repeat DSA is mandatory and bears the usual risk of invasive angiography. The present study attempts to assess the diagnostic impact of 3 D rotational angiography in order to avoid repeat DSA. Results: In the second DSA scan, 4 aneurysms in 4 patients (4/91; 4.4 %) were found and treated subsequently. Within the first 4.5 years of this study, 401 patients with SAH were treated and 61 of them underwent repeat angiography (15.2 %) compared to 30 of 248 patients (12.1 %) in the last 4.5 years of this study. In the first group we found 3 aneurysms during repeat angiography, and in the second group we found 1. No significance was reached (p = 0.29) but there was a tendency towards higher diagnostic security using 3D-DSA. Conclusion: Using 3 D rotational DSA in initial imaging workup might help to reduce falsenegative results concerning the bleeding source of acute SAH. At least because of this fact, 3 D rotational DSA should be part of the diagnostic workup after acute SAH. Key Points:▶ In 15 % of SAH patients no causative vascular lesion can be found using conventional DSA compared to 12 % using 3 D DSA.

Cerebral Angiography for Evaluation of Patients with CT Angiogram-Negative Subarachnoid Hemorrhage: An 11-Year Experience

“…3D rotational angiography was not routinely performed, and the benefit of this technique in the evaluation of SAH remains controversial. 26,27 These data further underscore the importance of pursuing DSA in patients with CTA negative for SAH to identify a treatable vascular pathology.…”

Neurointensivmedizin: aneurysmatische Subarachnoidalblutung – State of the Art

“…Die Symptomatik der SAB ist typischerweise gekennzeichnet durch einen starken, in dieser Form noch nie aufgetretenen Kopfschmerz (Vernichtungskopfschmerz). Merke Die digitale Subtraktionsangiografie der intrakraniellen und extrakraniellen Blutgefäße (DSA) ist nach wie vor Goldstandard in der Diagnostik der Subarachnoidalblutung [6].…”

Neurointensivmedizin: aneurysmatische Subarachnoidalblutung – State of the Art

“…Die digitale Subtraktionsangiografie der intrakraniellen und extrakraniellen Blutgefäße (DSA) ist nach wie vor Goldstandard in der Diagnostik der Subarachnoidalblutung [6].…”