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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Second catheter angiography after initially negative invasive and non-invasive Imaging in patients with atraumatic subarachnoidal hemorrhage

Meeting Abstract

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  • Adrian Ringelstein - Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen
  • Oliver Mueller - Neurochirurgische Klinik, Universitätsklinikum Essen
  • Sophia L. Goericke - Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen
  • Christoph Moenninghoff - Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen
  • Ulrich Sure - Neurochirurgische Klinik, Universitätsklinikum Essen
  • Michael Forsting - Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen
  • Marc Schlamann - Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMI.11.06

doi: 10.3205/13dgnc371, urn:nbn:de:0183-13dgnc3718

Published: May 21, 2013

© 2013 Ringelstein et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: This study aimed to determine the yield of DSA for the detection of causative vascular lesions in patients with atraumatic SAH and negative initial noninvasive and invasive neurovascular examinations (CTA, DSA and MRA).

Method: We retrospectively evaluated 7147 invasive catheter angiographies between 2004 and 2012 from our PACS System. 90 patients presented with subarachnoidal hemorrhage and repetitive DSA because initial non-invasive and invasive imaging was negative concerning a causative vascular lesion. Two neuroradiologists reanalyzed the initial imaging and the result of repetitive DSA independently to find out if a second DSA might be helpful in detecting an initially occult bleeding source.

Results: Repetitive DSA demonstrated a causative vascular lesion in 4 patients (4.5%). In all other patients no causative vascular lesion was found. Since the implementation of 3D rotational DSA in 2008 only one more causative vascular lesion was found during repetitive DSA and the rate of initially negative imaging and accordingly the number of necessary reangiographies approximately halved although the number of acute SAH did not change significantly.

Conclusions: Repetitive DSA revealed a cause for SAH after initially negative imaging diagnostics in some rare cases and the detection rate decreased after implementation of 3D rotational DSA. But as these findings have a therapeutic and prognostic impact, we think that a repetitive DSA can be recommended in patients with SAH, even under consideration of the risk of a second invasive diagnostic angiography itself. Interdisciplinary evaluation and double reading of the initial imaging might be helpful to avoid repetitive DSA.