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

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36 Scopus citations

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
StatePublished - Apr 2013

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Dalyai, R., Chalouhi, N., Theofanis, T., Jabbour, P. M., Dumont, A. S., Gonzalez, L. F., Gordon, D. S., Rosenwasser, R. H., & Tjoumakaris, S. I. (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, 72(4), 646-651.