Document Detail


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.
MedLine Citation:
PMID:  23277373     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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
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Publication Detail:
Type:  Case Reports; Evaluation Studies; Journal Article; Review    
Journal Detail:
Title:  Neurosurgery     Volume:  72     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-21     Completed Date:  2013-12-18     Revised Date:  2014-07-06    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  646-52; discussion 651-2     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Catheterization / methods*,  trends
Cerebral Angiography / methods*,  trends
Follow-Up Studies
Humans
Prospective Studies
Reproducibility of Results
Retrospective Studies
Subarachnoid Hemorrhage / radiography*,  therapy*
Time Factors
Treatment Outcome
Comments/Corrections
Erratum In:
Neurosurgery. 2013 Nov;73(5):E913
Note: Thakkar, Vismay [added]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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