What Is The Need For Repeat Angiography In Spontaneous Subarachnoid Hemorrhages With Negative Initial Angiogram?

Abstract

Objective: Repeat angiography is usually performed in spontaneous SAH patients who have negative initial angiography. In this study we aimed to evaluate the yield of repeat angiography in spontaneous SAH with different clinics and bleeding paterns.
 Methods: A retrospective analysis was performed on spontaneous SAH patients who admitted to our neurosurgery clinic. The patients were divided into two groups as perimesencephalic and nonperimesencephalic SAH according to their bleeding patern on cerebral CT. Demographic and clinic data, routine follow-up cerebral angiography within 2 weeks, complications due to repeated cerebral angiography and the presence of new detected vascular pathology were all recorded.
 Results: 208 patients with spontaneous SAH with mean age 60.00±15.82 (20-83) years were included. The Fisher score was found lower in perimesencephalic SAH patients. Mortality was also seen more frequently in nonperimesencephalic SAH. In repeat angiography vascular pathology related with SAH was found in only nonperimesencephalic SAH patients without any statistically significancy (0 vs 4, p:0.078). The incidence of complications due to repeat angiography was similiar in both groups.
 Conclusion: In conclusion clinicians should consider to evaluate the spontaneous SAH with subsequent neuroimaging tests once more to rule out cerebral vascular pathologies. Our data suggested that perimesencephalic SAH has a better Fisher score and less mortality when compared with nonperimesencephalic SAH. Our perimesencephalic SAH patients have no vascular pathology even after repeat angiography. Therefore high quality MR angiography or CTangiography can be easily performed rather than cerebral angiography which is an invasive imaging method. Cerebral angiography should be considered only in suspected cases with perimesencephalic SAH.