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Neurosurgery. 2012 May;70(5):1135-42. doi: 10.1227/NEU.0b013e318242575e.

Diagnostic yield of repeat catheter angiography in patients with catheter and computed tomography angiography negative subarachnoid hemorrhage.

Author information

1
Division of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri, USA. josser.delgado@crlmed.com

Abstract

BACKGROUND:

The yield of repeat catheter angiography in patients with subarachnoid hemorrhage (SAH) who have negative initial catheter and computed tomography (CT) angiograms is not well understood.

OBJECTIVE:

To determine the yield of repeat catheter angiography in a prospective cohort of patients with SAH and negative initial catheter and CT angiograms.

METHODS:

From January 1, 2005, until September 1, 2010, we instituted a prospective protocol in which patients with SAH documented by noncontrast CT (NCCT) or cerebrospinal fluid (CSF) xanthochromia and negative initial catheter and CT angiograms were evaluated with repeat catheter angiography 7 days and 3 months after presentation to assess for causative vascular abnormalities.

RESULTS:

Seventy-two patients were included, with a mean age of 53.1 years (median, 53.5 years; range, 19-88 years). Forty-six patients were female (63.9%) and 26 male (36.1%). Thirty-nine patients had nonperimesencephalic SAH (54.2%), 29 patients had perimesencephalic SAH (40.3%), and 4 patients had CSF xanthochromia (5.5%). The first repeat catheter angiogram performed 7 days after presentation demonstrated a causative vascular abnormality in 3 patients (yield of 4.2%), 2 of which had nonperimesencephalic SAH (yield of 5.1%), and 1 had perimesencephalic SAH (yield of 3.4%). The second repeat catheter angiogram performed in 43 patients (59.7%) did not demonstrate any causative vascular abnormalities. No causative abnormalities were found in patients with CSF xanthochromia.

CONCLUSION:

Repeat catheter angiography performed 7 days after presentation is valuable in the evaluation of patients with SAH who have negative initial catheter and CT angiograms, demonstrating a causative vascular abnormality in 4.2% of patients.

PMID:
22105208
DOI:
10.1227/NEU.0b013e318242575e
[Indexed for MEDLINE]

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