Utility of Delayed Digital Subtraction Angiography (DSA) in CT Angiography or Immediate DSA Negative Spontaneous Subarachnoid Hemorrhage (P04.075)

Abstract

Objective: To determine the utility of delayed digital subtraction angiography (DSA) in CT angiography and immediate DSA negative spontaneous subarachnoid hemorrhage (SAH). Background 15% - 20% of patients presenting with spontaneous SAH are known to have no aneurysm or other underlying vascular abnormality detected on their initial vascular imaging. The standard protocol in many institutions is to perform delayed (1 week to 3 months) DSA in patients whose initial imaging (CTA and/or immediate DSA) is negative to find a previously occult aneurysm. Recently, the practice of performing an immediate DSA after negative CTA has been questioned. Our institutional data was reviewed to find if delayed DSA provided any advantage over previously acquired information. Design/Methods: Retrospective review of consecutive SAH cases presenting to a tertiary care hospital from 01/01/2001 to 08/31/2011 was performed. All cases with a known traumatic cause or CTA negative with no follow up DSA were excluded from analysis. The outcomes of delayed DSA were compared to immediate DSA. Results: Of total 547 patients records reviewed, 70 were found to be CTA negative non-traumatic SAH with an immediate DSA follow up study. Immediate DSA was performed on an average 1.32 days after initial CTA. Of these, 10 were found to have a source of bleed on immediate DSA. 20 patients of remaining 60 underwent delayed DSA on an average of 46.35 days after first DSA. Of them, only 1 was found to have an aneurysm giving a yield of 5%. Conclusions: Though the results are based on a small patient pool, the yield of delayed DSA in an initial non-aneurysmal spontaneous SAH is low enough that the wisdom of delayed DSA warrants further exploration. Disclosure: Dr. Jethwa has nothing to disclose. Dr. Punia has nothing to disclose. Dr. Gandhi has nothing to disclose. Dr. Prestigiacomo has nothing to disclose.