Subarachnoid hemorrhage with negative initial catheter angiography: a review of 254 cases evaluating patient clinical outcome and efficacy of short- and long-term repeat angiography.

Abstract

BACKGROUND:

Subarachnoid hemorrhage (SAH) is found to have no vascular origin by initial catheter angiography in approximately 15% of cases. The most appropriate course for the type and frequency of additional diagnostic workup remains controversial.

OBJECTIVE:

To retrospectively assess the diagnostic yield of short-term and long-term repeat catheter angiography in the era of advanced imaging.

METHODS:

Between 2003 and 2011, 254 consecutive patients diagnosed with SAH had negative initial angiography. SAH was perimesencephalic (PM) in 46.5% and nonperimesencephalic (NPM) in 53.5%. Angiography was repeated at 1-week (short-term) and 6-week (long-term) intervals from the initial negative angiogram.

RESULTS:

Ten of 254 patients had a vascular source of hemorrhage on short-term follow-up angiography with a diagnostic yield of 3.9%. One hundred seventy-four patients with negative findings on the first 2 angiograms received a third angiogram, and 7 of these patients were found to have a vascular abnormality. The estimated yield of this third angiogram was 4.0%. The overall diagnostic yield of repeat angiography was 0% in the PM group and 12.5% in the NPM group. The diagnostic yield of short-term and long-term follow-up angiography in patients with NPM SAH was 7.3% and 7.8%, respectively. NPM patients were more likely to experience vasospasm and hydrocephalus requiring external ventricular drainage or cerebrospinal fluid diversion than PM patients.

CONCLUSION:

Our results support a protocol of short-term and long-term angiographic follow-up in patients with NPM SAH and negative initial angiography. Aggressive protocols of follow-up angiography may not be necessary in patients with PM SAH.

• Authors: Richard Dalyai, Nohra Chalouhi, Thana Theofanis, Pascal M Jabbour, Aaron S Dumont, L Fernando Gonzalez, David S Gordon, Vismay Thakkar, Robert H Rosenwasser, Stavropoula I Tjoumakaris
• Journal: Neurosurgery (Neurosurgery) Vol. 72 Issue 4 Pg. 646-52; discussion 651-2 (Apr 2013) ISSN: 1524-4040 [Electronic] United States
• PMID: 23277373 (Publication Type: Case Reports, Evaluation Study, Journal Article, Review)

Topics

• Catheterization (methods, trends)
• Cerebral Angiography (methods, trends)
• Follow-Up Studies
• Humans
• Prospective Studies
• Reproducibility of Results
• Retrospective Studies
• Subarachnoid Hemorrhage (diagnostic imaging, therapy)
• Time Factors
• Treatment Outcome