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

Richard Dalyai, Nohra Chalouhi, Thana Theofanis, Pascal M. Jabbour, Aaron S. Dumont, L. Fernando Gonzalez, David S. Gordon, Robert H. Rosenwasser, Stavropoula I. Tjoumakaris

Research output: Contribution to journalArticle

35 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)646-651
Number of pages6
JournalNeurosurgery
Volume72
Issue number4
DOIs
StatePublished - Apr 2013
Externally publishedYes

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Subarachnoid Hemorrhage
Angiography
Catheters
Blood Vessels
Hydrocephalus
Hemorrhage

Keywords

  • Aneurysms
  • Digital subtraction angiography
  • Occult vascular lesions
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

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. / Dalyai, Richard; Chalouhi, Nohra; Theofanis, Thana; Jabbour, Pascal M.; Dumont, Aaron S.; Gonzalez, L. Fernando; Gordon, David S.; Rosenwasser, Robert H.; Tjoumakaris, Stavropoula I.

In: Neurosurgery, Vol. 72, No. 4, 04.2013, p. 646-651.

Research output: Contribution to journalArticle

Dalyai, R, Chalouhi, N, Theofanis, T, Jabbour, PM, Dumont, AS, Gonzalez, LF, Gordon, DS, Rosenwasser, RH & Tjoumakaris, SI 2013, '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', Neurosurgery, vol. 72, no. 4, pp. 646-651. https://doi.org/10.1227/NEU.0b013e3182846de8
Dalyai, Richard ; Chalouhi, Nohra ; Theofanis, Thana ; Jabbour, Pascal M. ; Dumont, Aaron S. ; Gonzalez, L. Fernando ; Gordon, David S. ; Rosenwasser, Robert H. ; Tjoumakaris, Stavropoula I. / 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. In: Neurosurgery. 2013 ; Vol. 72, No. 4. pp. 646-651.
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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.",
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T2 - A review of 254 cases evaluating patient clinical outcome and efficacy of short-and long-term repeat angiography

AU - Dalyai, Richard

AU - Chalouhi, Nohra

AU - Theofanis, Thana

AU - Jabbour, Pascal M.

AU - Dumont, Aaron S.

AU - Gonzalez, L. Fernando

AU - Gordon, David S.

AU - Rosenwasser, Robert H.

AU - Tjoumakaris, Stavropoula I.

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N2 - 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.

AB - 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.

KW - Aneurysms

KW - Digital subtraction angiography

KW - Occult vascular lesions

KW - Subarachnoid hemorrhage

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