Ahead of Print: Diagnostic Yield of Repeat Catheter Angiography in Patients with Catheter and CT Angiography Negative Subarachnoid Hemorrhage
BACKGROUND: The yield of repeat catheter angiography in patients with subarachnoid hemorrhage (SAH) who have negative initial catheter and 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 1st, 2005, until September 1st, 2010, we instituted a prospective protocol in which patients with SAH documented by non-contrast 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 non-perimesencephalic 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 non-perimesencephalic 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.