Should Cerebral Angiography Be Avoided within Three Hours after Subarachnoid Hemorrhage?
- Author:
Hong AN
1
;
Jaechan PARK
;
Dong Hun KANG
;
Wonsoo SON
;
Young Sup LEE
;
Youngseok KWAK
;
Boram OHK
Author Information
- Publication Type:Original Article
- Keywords: Aneurysm, Ruptured; Angiography; Intracranial aneurysm; Subarachnoid hemorrhage
- MeSH: Aneurysm; Aneurysm, Ruptured; Angiography; Angiography, Digital Subtraction; Catheters; Cerebral Angiography; Emergencies; Hemorrhage; Humans; Hypertension; Intracranial Aneurysm; Logistic Models; Multivariate Analysis; Risk Factors; Subarachnoid Hemorrhage
- From:Journal of Korean Neurosurgical Society 2019;62(5):526-535
- CountryRepublic of Korea
- Language:English
- 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.
