Evaluation of Patients With Spontaneous Subarachnoid Hemorrhage and Negative Angiography

Little, Andrew S.; Garrett, Mark P.; Germain, Rasha; Farhataziz, Nabeel; Albuquerque, Felipe C.; McDougall, Cameron G.; Zabramski, Joseph M.; Nakaji, Peter; Spetzler, Robert F.

doi:10.1227/01.neu.0000306091.30517.e7

Cited by 72 publications

(64 citation statements)

References 51 publications

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“…6 Furthermore, the retrospective study by Little et al showed that 3 of 4 newly discovered aneurysms would have also been detected by CTA. 15 This finding is in line with those in a recent meta-analysis by Westerlaan et al, who demonstrated that high-resolution CTA might be considered an alternative to DSA as the primary imaging tool for detecting cerebral vascular abnormalities. 20,21 Nevertheless, studies directly comparing repeat CTA and repeat DSA are lacking.…”

Section: Discussionsupporting

confidence: 89%

“…4,9,12,17 The same may hold true for the second category of patients with CSF xanthochromia. 11,15,18,19 The third category is the most challenging. Probable causes for initially negative findings in these patients may be a thrombosed cerebral aneurysm or severe vasospasm.…”

Section: ©Aans 2014mentioning

confidence: 99%

“…1), 8 of which met the inclusion criteria. 1,2,5,7,13,15,16,23 Results for these studies are summarized in Table 1. Three hundred sixty-eight patients, including those from the Groningen series, were eligible for the pooled analysis.…”

Section: Pooled Analysismentioning

confidence: 99%

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Repeat digital subtraction angiography after a negative baseline assessment in nonperimesencephalic subarachnoid hemorrhage: a pooled data meta-analysis

Bakker¹,

Groen²,

Foumani³

et al. 2014

JNS

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Object A repeat digital subtraction angiography (DSA) study of the cranial vasculature is routinely performed in patients with diffuse nonperimesencephalic subarachnoid hemorrhage (SAH) after negative baseline CT angiography (CTA) and DSA studies. However, DSA carries a low but substantial risk of neurological complications. Therefore, the authors evaluated the added value of repeat DSA in patients with initial angiographically negative diffuse nonperimesencephalic SAH. Methods A systematic review of the contemporary literature was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Studies from January 2000 onward were reviewed since imaging modalities have much improved over the last decade. A pooled analysis was conducted to identify the detection rate of repeat DSA. In addition, the diagnostic yield of repeat DSAs in a prospectively maintained single-center series of 1051 consecutive patients with SAH was added to the analysis. Results An initial search of the literature yielded 179 studies, 8 of which met the selection criteria. Another 45 patients from the authors' institution were included in the study, providing 368 patients eligible for the pooled analysis. In 37 patients (10.0%, 95% CI 7.4%–13.6%) an aneurysm was detected on repeat DSA. The timing of the repeat DSA varied from 1 to 6 weeks after the initial DSA. The use of 3D techniques was poorly described among these studies, and no direct comparisons between CTA and DSA were made. Conclusions Repeat DSA is still warranted in patients with a diffuse nonperimesencephalic SAH and negative initial assessment. However, the exact timing of the repeat DSA is subject to debate.

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Section: Discussionsupporting

confidence: 89%

Section: ©Aans 2014mentioning

confidence: 99%

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Repeat digital subtraction angiography after a negative baseline assessment in nonperimesencephalic subarachnoid hemorrhage: a pooled data meta-analysis

Bakker¹,

Groen²,

Foumani³

et al. 2014

JNS

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“…Traumatic SAH was excluded. Convexity type SAH was also excluded by consensus because it is usually secondary to defined pathologies with different diagnostic and treatment protocols 38,49 . From the 1.149 total cases, 929 (81%) were aneurismal SAH (ANSAH), including 55 patients who died before angiography.…”

Section: Methodsmentioning

confidence: 99%

“…The reported incidence of ISAH in Spain (27,47% in Barcelona 40 , 30,9% in Valencia 48 , 27% in Madrid 33 ), is traditionally higher than in other countries. Managing patients with SAH of unknown origin can be a challenge, because of the uncertainty of their evolution and the lack of evidence about best management measures, but there are few large or multicentre series' reports about ISAH 4,38,20,56,75 . The SENEC Vascular Pathology Group from Spain designed a multicentre data base registry on spontaneous SAH.…”

Section: Introductionmentioning

confidence: 99%

Idiopathic subarachnoid hemorrhage: a multicentre series of 220 patients

et al. 2010

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SummaryBackground. The Spanish neurosurgical society created a multicentre data base on spontaneous SAH to analyze the real problematic of this disease in our country. This paper focuses on the group of patients with idiopathic SAH (ISAH).Methods. 16 participant hospitals collect their spontaneous SAH cases in a common data base shared in the internet through a secured web page, considering clinical, radiological, evolution and outcome variables. The 220 ISAH cases collected from November 2004 to November 2007 were statistically analyzed as a whole and divided into 3 subgroups depending on the CT blood pattern (aneurysmal, perimesencephalic, or normal).Results. Resultados. Los 220 pacientes con HSAI representan el 19% del total de 1.149 pacientes con HSA recogidos en la base de datos en el mismo periodo.El 46,8% de los casos de HSAI presentaron patrón de sangrado aneurismático en TC, hecho que se correlacionó con mayor edad, peor condición clínica al ingreso, mayor grado Fisher de sangrado, más frecuencia de hidrocefalia y peor evolución, comparados con los casos de HSAI con sangrado en TC del tipo perimesencefálico (42,7%) o con TC normal (10,4%).Una vez superada la fase aguda, e independientemente del tipo de sangrado inicial, la evolución de los pacientes con HSAI es globalmente buena y significativamente mejor que la de los pacientes con HSA aneurismática. La única variable con valor pronóstico en los casos de HSAI, tras realizar un análisis de Idiopathic subarachnoid hemorrhage: a multicentre series of 220 patients

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Internal Carotid Artery Bifurcation Aneurysm: Spontaneous Thrombosis of an Incidental ICA Bifurcation Aneurysm Despite Dual Platelet Function Inhibition

Gihr

Felber

Bäzner

et al. 2019

The Aneurysm Casebook

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Evaluation of Patients With Spontaneous Subarachnoid Hemorrhage and Negative Angiography

Abstract: These data suggest useful modifications to current diagnostic paradigms for patients with angiographically negative spontaneous SAH.

Cited by 72 publications

References 51 publications

Repeat digital subtraction angiography after a negative baseline assessment in nonperimesencephalic subarachnoid hemorrhage: a pooled data meta-analysis

Repeat digital subtraction angiography after a negative baseline assessment in nonperimesencephalic subarachnoid hemorrhage: a pooled data meta-analysis

Idiopathic subarachnoid hemorrhage: a multicentre series of 220 patients

Internal Carotid Artery Bifurcation Aneurysm: Spontaneous Thrombosis of an Incidental ICA Bifurcation Aneurysm Despite Dual Platelet Function Inhibition

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