Abstract
BackgroundTo identify patients with spontaneous subarachnoid hemorrhage for whom CT angiography alone can exclude ruptured aneurysms.MethodsAn observational retrospective review was carried out of all consecutive patients with non-traumatic subarachnoid hemorrhage who underwent both CT angiography and catheter angiography to exclude an aneurysm. CT angiography negative cases (no aneurysm) were classified according to their CT hemorrhage pattern as "aneurismal", "perimesencephalic" or as "no-hemorrhage."ResultsTwo hundred and forty-one patients were included. A CT angiography aneurysm detection sensitivity and specificity of 96.4% and 96.0% were observed. All 35 cases of perimesencephalic or no-hemorrhage out of 78 CT angiography negatives also had negative angiography findings.ConclusionsCT angiography is self-reliant to exclude ruptured aneurysms when either a perimesencephalic hemorrhage or no-hemorrhage pattern is identified on the CT within a week of symptom onset.
Highlights
To identify patients with spontaneous subarachnoid hemorrhage for whom CT angiography alone can exclude ruptured aneurysms
Eighty-five percent of non-traumatic subarachnoid hemorrhage (SAH) are caused by ruptured intracranial aneurysms
When the CT is positive for subarachnoid blood, the combination of digital subtraction angiography (DSA) with 3D rotational angiography (3DRA) has been and is still considered the gold standard [2,3,4,5,6]
Summary
To identify patients with spontaneous subarachnoid hemorrhage for whom CT angiography alone can exclude ruptured aneurysms. Spontaneous subarachnoid hemorrhage (SAH) is a subtype of hemorrhagic stroke with an extremely poor prognosis. Eighty-five percent of non-traumatic SAHs are caused by ruptured intracranial aneurysms. Ten percent fit into the non-aneurismal perimesencephalic hemorrhage (PMH) pattern, whose etiology remains debated. CT angiography (CTA) has improved to a sensitivity of about 95% for detecting ruptured aneurysms, when compared to DSA [7,8,9]. In many centers, patients with SAH undergo CTA first which is often the basis for an endovascular or neurosurgical approach [10,11,12].
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