Repeat Catheter Angiography in Patients with Aneurysmal-Pattern Angiographically Negative Subarachnoid Hemorrhage

2021 ◽  
Author(s):  
Cody L. Nesvick ◽  
Soliman Oushy ◽  
Krishnan Ravindran ◽  
Lorenzo Rinaldo ◽  
Panagiotis Kerezoudis ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Catheter Angiography

Blister Aneurysm of the Internal Carotid Artery

2019 ◽  
pp. 5-13
Author(s):  
Peter Nakaji ◽  
Michael R. Levitt
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Surgical Management ◽  
Medical Management ◽  
Internal Carotid ◽  
Conventional Imaging ◽  
Catheter Angiography ◽  
Intraoperative Rupture ◽  
Open Management

Abstract: Blister aneurysms are a rare cause of subarachnoid hemorrhage. They are easily overlooked on conventional imaging and catheter angiography due to their small size and unusual anatomic location. Whereas the medical management of subarachnoid hemorrhage is similar to that of saccular aneurysms, the surgical management of blister aneurysms is more challenging due to their unique pathology and higher risk of intraoperative rupture. Special consideration should be made for open management such as preparation of the option of bypass or the emerging use of endovascular techniques such as flow diversion. This chapter reviews the diagnosis and medical and surgical management of blister aneurysms.

Subarachnoid hemorrhage without evident cause on initial angiography studies: diagnostic yield of subsequent angiography and other neuroimaging tests

2003 ◽  
Vol 98 (6) ◽  
pp. 1235-1240 ◽  
Author(s):  
Mehmet A. Topcuoglu ◽  
Christopher S. Ogilvy ◽  
Bob S. Carter ◽  
Ferdinando S. Buonanno ◽  
Walter J. Koroshetz ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Mr Imaging ◽  
Ct Angiography ◽  
Mr Angiography ◽  
Diagnostic Yield ◽  
Catheter Angiography ◽  
Content Type ◽  
Spine Mr ◽  
Susceptibility Contrast ◽  
Fine Print

Object. The aim of this study was to assess the diagnostic yield of imaging tests performed in patients in whom the cause of subarachnoid hemorrhage (SAH) had not been demonstrated on initial angiography. Methods. By reviewing medical records of 806 patients with SAH who had been admitted during a 6.5-year period, the authors identified 86 in whom initial transfemoral catheter angiography failed to reveal the cause of SAH. Clinical and radiological data were analyzed to determine the diagnostic yield of subsequent catheter angiography, computerized tomography (CT) angiography, magnetic resonance (MR) angiography, and MR imaging of the brain and spine for various subtypes of SAH (bleeding not visualized on CT studies [CT-negative SAH], perimesencephalic SAH, and nonperimesencephalic SAH). Of 41 patients with nonperimesencephalic SAH, 36, 32, and 21 underwent repeated catheter angiography, CT angiography, and MR angiography, respectively; brain MR imaging was performed in 23 patients (18 with Gd and 15 with susceptibility contrast sequences), and spine MR imaging in 17. Of 36 patients with perimesencephalic SAH, 31, 23, and 17 underwent repeated catheter angiography, CT angiography, and MR angiography, respectively; brain MR imaging was performed in 18 patients (17 with Gd and 11 with susceptibility contrast sequences), and spine MR imaging in 14. Of nine patients with SAH not visualized on CT scanning, three, one, and six underwent repeated catheter angiography, CT angiography, and MR angiography, respectively; brain MR imaging was performed in eight patients (five with Gd and three with susceptibility contrast sequences), and spine MR imaging in seven. The cause of SAH could be determined in only four patients, all with nonperimesencephalic SAH. The only test that yielded a diagnosis was catheter angiography (three aneurysms on the second and one on the third angiography, all surgically secured). Diffusion-weighted MR imaging demonstrated small, deep infarcts in five patients. Conclusions. Repeated catheter angiography remains the most sensitive test to determine the cause of SAH that is not demonstrated on initial angiography, particularly in the subtype of nonperimesencephalic SAH. Newer, noninvasive imaging techniques provide little diagnostic yield.

scholarly journals Diagnostic Yield of Catheter Angiography in Patients with Subarachnoid Hemorrhage and Negative Initial Noninvasive Neurovascular Examinations

2012 ◽  
Vol 34 (4) ◽  
pp. 833-839 ◽  
Author(s):  
J.E. Delgado Almandoz ◽  
B.M. Crandall ◽  
J.L. Fease ◽  
J.M. Scholz ◽  
R.E. Anderson ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Diagnostic Yield ◽  
Catheter Angiography

scholarly journals Is there added value in obtaining cervical spine MRI in the assessment of nontraumatic angiographically negative subarachnoid hemorrhage? A retrospective study and meta-analysis of the literature

2018 ◽  
Vol 129 (3) ◽  
pp. 670-676 ◽  
Author(s):  
Gelareh Sadigh ◽  
Chad A. Holder ◽  
Jeffrey M. Switchenko ◽  
Seena Dehkharghani ◽  
Jason W. Allen
Keyword(s):  
Cervical Spine ◽  
Subarachnoid Hemorrhage ◽  
Diagnostic Yield ◽  
Vascular Malformations ◽  
Meta Analysis ◽  
Added Value ◽  
Catheter Angiography ◽  
Optimal Method ◽  
Study Heterogeneity ◽  
Spine Mri

OBJECTIVEDiagnostic algorithms for nontraumatic angiographically negative subarachnoid hemorrhage (AN-SAH) vary, and the optimal method remains subject to debate. This study assessed the added value of cervical spine MRI in identifying a cause for nontraumatic AN-SAH.METHODSConsecutive patients 18 years of age or older who presented with nontraumatic SAH between February 1, 2009, and October 31, 2014, with negative cerebrovascular catheter angiography and subsequent cervical MRI were studied. Patients with intraparenchymal, subdural, or epidural hemorrhage; recent trauma; or known vascular malformations were excluded. All cervical MR images were reviewed by two blinded neuroradiologists. The diagnostic yield of cervical MRI was calculated. A literature review was conducted to identify studies reporting the diagnostic yield of cervical MRI in patients with AN-SAH. The weighted pooled estimate of diagnostic yield of cervical MRI was calculated.RESULTSFor all 240 patients (mean age 53 years, 48% male), catheter angiography was performed within 4 days after admission (median 12 hours, interquartile range [IQR] 10 hours). Cervical MRI was performed within 19 days of admission (median 24 hours, IQR 10 hours). In a single patient, cervical MRI identified a source for SAH (cervical vascular malformation). Meta-analysis of 7 studies comprising 538 patients with AN-SAH produced a pooled estimate of 1.3% (95% confidence interval 0.5%–2.5%) for diagnostic yield of cervical MRI. No statistically significant between-study heterogeneity or publication bias was identified.CONCLUSIONSCervical MRI following AN-SAH, in the absence of findings to suggest spinal etiology, has a very low diagnostic yield and is not routinely necessary.

The Role of Antiplatelet Medications in Angiogram-Negative Subarachnoid Hemorrhage

Neurosurgery ◽  
2014 ◽  
Vol 75 (5) ◽  
pp. 530-535 ◽  
Author(s):  
Jason A. Ellis ◽  
Michael M. McDowell ◽  
Stephan A. Mayer ◽  
Sean D. Lavine ◽  
Philip M. Meyers ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Odds Ratio ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Medication Use ◽  
Antiplatelet Agents ◽  
Columbia University ◽  
Modified Rankin Scale ◽  
Catheter Angiography ◽  
Antiplatelet Medication

Abstract BACKGROUND: The use of antiplatelet medications has greatly expanded and this has been associated with an increased rate of complications after aneurysmal subarachnoid hemorrhage (SAH). The influence of antiplatelet medications on outcomes after non-aneurysmal SAH is unknown. OBJECTIVE: To analyze the frequency and impact on outcome of antiplatelet medication use among patients with angiogram-negative SAH. METHODS: An analysis of patients within the Columbia University SAH Outcomes Project database was performed. All patients who underwent catheter cerebral angiography after presenting with nontraumatic SAH between 1996 and 2013 were included. Outcomes were assessed by using the modified Rankin Scale. RESULTS: A total of 1351 patients underwent catheter angiography for evaluation of SAH. Of these, 173 (13%) were designated angiogram-negative. The fraction of patients presenting with angiogram-negative SAH as well as the frequency of antiplatelet use among these patients significantly increased during the study period. Antiplatelet use was more commonly associated with angiogram-negative SAH than with angiogram-positive SAH (27% vs 14%, P = .001). At 14 days after presentation, poor outcome was significantly more frequent among patients who took antiplatelet agents than among those who did not (38% vs 20%, P = .017). This effect was also seen after multivariate analysis (odds ratio, 2.58; P = .034), although no difference was observed by 12 months (P > .05). CONCLUSION: Antiplatelet medication use is associated with poor early, but not late, outcomes after angiogram-negative SAH. Corresponding increased rates of antiplatelet medication use and angiogram-negative SAH may be related. Additional studies are needed to confirm this association.

scholarly journals The Importance of Catheter Angiography in Computed Tomography Angiography-Negative Subarachnoid Hemorrhage

Cureus ◽  
2017 ◽  
Author(s):  
Ali S Haider ◽  
Caleb Gottlich ◽  
Anadjeet Khahera ◽  
Steven Vayalumkal ◽  
Umair Khan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Computed Tomography Angiography ◽  
Catheter Angiography

scholarly journals Yield of Catheter Angiography After Computed Tomography Negative, Lumbar Puncture Positive Subarachnoid Hemorrhage

Stroke ◽  
2013 ◽  
Vol 44 (6) ◽  
pp. 1729-1731 ◽  
Author(s):  
Adam N. Wallace ◽  
Jeffrey N. Dines ◽  
Gregory J. Zipfel ◽  
Colin P. Derdeyn
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Lumbar Puncture ◽  
Catheter Angiography

Diagnostic Yield of Repeat Catheter Angiography in Patients With Catheter and Computed Tomography Angiography Negative Subarachnoid Hemorrhage

Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1135-1142 ◽  
Author(s):  
Josser E. Delgado Almandoz ◽  
Bharathi D. Jagadeesan ◽  
Daniel Refai ◽  
Christopher J. Moran ◽  
DeWitte T. Cross ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Subarachnoid Hemorrhage ◽  
Computed Tomography Angiography ◽  
Prospective Cohort ◽  
Diagnostic Yield ◽  
Catheter Angiography ◽  
Vascular Abnormality ◽  
Vascular Abnormalities ◽  
Noncontrast Ct

Abstract BACKGROUND: The yield of repeat catheter angiography in patients with subarachnoid hemorrhage (SAH) who have negative initial catheter and computed tomography (CT) angiograms is not well understood. OBJECTIVE: To determine the yield of repeat catheter angiography in a prospective cohort of patients with SAH and negative initial catheter and CT angiograms. METHODS: From January 1, 2005, until September 1, 2010, we instituted a prospective protocol in which patients with SAH documented by noncontrast CT (NCCT) or cerebrospinal fluid (CSF) xanthochromia and negative initial catheter and CT angiograms were evaluated with repeat catheter angiography 7 days and 3 months after presentation to assess for causative vascular abnormalities. RESULTS: Seventy-two patients were included, with a mean age of 53.1 years (median, 53.5 years; range, 19-88 years). Forty-six patients were female (63.9%) and 26 male (36.1%). Thirty-nine patients had nonperimesencephalic SAH (54.2%), 29 patients had perimesencephalic SAH (40.3%), and 4 patients had CSF xanthochromia (5.5%). The first repeat catheter angiogram performed 7 days after presentation demonstrated a causative vascular abnormality in 3 patients (yield of 4.2%), 2 of which had nonperimesencephalic SAH (yield of 5.1%), and 1 had perimesencephalic SAH (yield of 3.4%). The second repeat catheter angiogram performed in 43 patients (59.7%) did not demonstrate any causative vascular abnormalities. No causative abnormalities were found in patients with CSF xanthochromia. CONCLUSION: Repeat catheter angiography performed 7 days after presentation is valuable in the evaluation of patients with SAH who have negative initial catheter and CT angiograms, demonstrating a causative vascular abnormality in 4.2% of patients.

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