J Korean Neurosurg Soc.  2019 Sep;62(5):526-535. 10.3340/jkns.2018.0238.

Should Cerebral Angiography Be Avoided within Three Hours after Subarachnoid Hemorrhage?

Affiliations
  • 1Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea. jparkmd@hotmail.com
  • 2Department of Neurosurgery, School of Medicine, Catholic University of Daegu, Daegu, Korea.
  • 3Clinical Trial Center, Kyungpook National University Hospital, Daegu, Korea.

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.

Keyword

Aneurysm, Ruptured; Angiography; Intracranial aneurysm; Subarachnoid hemorrhage

MeSH Terms

Aneurysm
Aneurysm, Ruptured
Angiography
Angiography, Digital Subtraction
Catheters
Cerebral Angiography*
Emergencies
Hemorrhage
Humans
Hypertension
Intracranial Aneurysm
Logistic Models
Multivariate Analysis
Risk Factors
Subarachnoid Hemorrhage*
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