gms | German Medical Science

Objective: Numerous studies stated that digital subtraction angiography (DSA) has become redundant in patients with isolated non-aneurysmal perimesencephalic subarachnoid hemorrhage (nPM-SAH). Thus we aimed to evaluate the use of digital subtraction angiography (DSA) compared to computed tomographic angiograms (CTAs), with regard to DSA-related complications und neurological outcome, as well as further clinical relevance.

Methods: We analyzed 73 patients, who met the criteria for nPM-SAH and were treated at our Department from 1993 to 2016. We reviewed all initial and subsequent images (CT, CTA and/or DSA), their radiological findings and procedure-related morbidity and mortality.

Results: Initially, native CT was performed in all patients as primary imaging. In addition, CT-angiography was done in 43 patients (59%), where the CTA findings were disputed in 8 patients (19%). None of these patients had an aneurysm in the subsequent DSA. In total, 117 DSAs were performed due to diagnosis of nPM-SAH. Ultimately, only one dissecting basilar artery aneurysm (0.9%) was newly discovered in the follow-up DSA, with initial negative CTA findings (2.3%). Of note, DSA-related complications occurred in 6.8% of patients. The reported complications included embolic strokes in all patients. One patient developed an expressive aphasia. A decompressive suboccipital craniectomy was done in another patient.

Conclusion: Our study demonstrated a very low detection rate of newly discovered aneurysms on follow-up angiography when compared to initial CTA findings in patients with nPM-SAH. Yet, DSA-related complications were not negligible. These findings are important as they suggest that primary CTA is sufficient in most cases.