Your browser doesn't support javascript.
loading
Should Cerebral Angiography Be Avoided within Three Hours after Subarachnoid Hemorrhage?
Journal of Korean Neurosurgical Society ; : 526-535, 2019.
Article in English | WPRIM | ID: wpr-765383
ABSTRACT

OBJECTIVE:

While the risk of aneurysmal rebleeding induced by catheter cerebral angiography is a serious concern and can delay angiography for a few hours after a subarachnoid hemorrhage (SAH), current angiographic technology and techniques have been much improved. Therefore, this study investigated the risk of aneurysmal rebleeding when using a recent angiographic technique immediately after SAH.

METHODS:

Patients with acute SAH underwent immediate catheter angiography on admission. A four-vessel examination was conducted using a biplane digital subtraction angiography (DSA) system that applied a low injection rate and small volume of a diluted contrast, along with appropriate control of hypertension. Intra-angiographic aneurysmal rebleeding was diagnosed in cases of extravasation of the contrast medium during angiography or increased intracranial bleeding evident in flat-panel detector computed tomography scans.

RESULTS:

In-hospital recurrent hemorrhages before definitive treatment to obliterate the ruptured aneurysm occurred in 11 of 266 patients (4.1%). Following a univariate analysis, a multivariate analysis using a logistic regression analysis revealed that modified Fisher grade 4 was a statistically significant risk factor for an in-hospital recurrent hemorrhage (p =0.032). Cerebral angiography after SAH was performed on 88 patients ≤3 hours, 74 patients between 3–6 hours, and 104 patients >6 hours. None of the time intervals showed any cases of intra-angiographic rebleeding. Moreover, even though the DSA ≤3 hours group included more patients with a poor clinical grade and modified Fisher grade 4, no case of aneurysmal rebleeding occurred during erebral angiography.

CONCLUSION:

Despite the high risk of aneurysmal rebleeding within a few hours after SAH, emergency cerebral angiography after SAH can be acceptable without increasing the risk of intra-angiographic rebleeding when using current angiographic techniques and equipment.
Subject(s)

Full text: Available Index: WPRIM (Western Pacific) Main subject: Subarachnoid Hemorrhage / Cerebral Angiography / Angiography / Angiography, Digital Subtraction / Logistic Models / Intracranial Aneurysm / Multivariate Analysis / Risk Factors / Aneurysm, Ruptured / Emergencies Type of study: Etiology study / Prognostic study Limits: Humans Language: English Journal: Journal of Korean Neurosurgical Society Year: 2019 Type: Article

Similar

MEDLINE

...
LILACS

LIS

Full text: Available Index: WPRIM (Western Pacific) Main subject: Subarachnoid Hemorrhage / Cerebral Angiography / Angiography / Angiography, Digital Subtraction / Logistic Models / Intracranial Aneurysm / Multivariate Analysis / Risk Factors / Aneurysm, Ruptured / Emergencies Type of study: Etiology study / Prognostic study Limits: Humans Language: English Journal: Journal of Korean Neurosurgical Society Year: 2019 Type: Article