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Should Cerebral Angiography Be Avoided within Three Hours after Subarachnoid Hemorrhage?

OBJECTIVE: While the risk of aneurysmal rebleeding induced by catheter cerebral angiography is a serious concern and can delay angiography for a few hours after a subarachnoid hemorrhage (SAH), current angiographic technology and techniques have been much improved. Therefore, this study investigated...

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Autores principales: An, Hong, Park, Jaechan, Kang, Dong-Hun, Son, Wonsoo, Lee, Young-Sup, Kwak, Youngseok, Ohk, Boram
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Neurosurgical Society 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732357/
https://www.ncbi.nlm.nih.gov/pubmed/31484228
http://dx.doi.org/10.3340/jkns.2018.0238
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author An, Hong
Park, Jaechan
Kang, Dong-Hun
Son, Wonsoo
Lee, Young-Sup
Kwak, Youngseok
Ohk, Boram
author_facet An, Hong
Park, Jaechan
Kang, Dong-Hun
Son, Wonsoo
Lee, Young-Sup
Kwak, Youngseok
Ohk, Boram
author_sort An, Hong
collection PubMed
description OBJECTIVE: While the risk of aneurysmal rebleeding induced by catheter cerebral angiography is a serious concern and can delay angiography for a few hours after a subarachnoid hemorrhage (SAH), current angiographic technology and techniques have been much improved. Therefore, this study investigated the risk of aneurysmal rebleeding when using a recent angiographic technique immediately after SAH. METHODS: Patients with acute SAH underwent immediate catheter angiography on admission. A four-vessel examination was conducted using a biplane digital subtraction angiography (DSA) system that applied a low injection rate and small volume of a diluted contrast, along with appropriate control of hypertension. Intra-angiographic aneurysmal rebleeding was diagnosed in cases of extravasation of the contrast medium during angiography or increased intracranial bleeding evident in flat-panel detector computed tomography scans. RESULTS: In-hospital recurrent hemorrhages before definitive treatment to obliterate the ruptured aneurysm occurred in 11 of 266 patients (4.1%). Following a univariate analysis, a multivariate analysis using a logistic regression analysis revealed that modified Fisher grade 4 was a statistically significant risk factor for an in-hospital recurrent hemorrhage (p =0.032). Cerebral angiography after SAH was performed on 88 patients ≤3 hours, 74 patients between 3–6 hours, and 104 patients >6 hours. None of the time intervals showed any cases of intra-angiographic rebleeding. Moreover, even though the DSA ≤3 hours group included more patients with a poor clinical grade and modified Fisher grade 4, no case of aneurysmal rebleeding occurred during erebral angiography. CONCLUSION: Despite the high risk of aneurysmal rebleeding within a few hours after SAH, emergency cerebral angiography after SAH can be acceptable without increasing the risk of intra-angiographic rebleeding when using current angiographic techniques and equipment.
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spelling pubmed-67323572019-09-12 Should Cerebral Angiography Be Avoided within Three Hours after Subarachnoid Hemorrhage? An, Hong Park, Jaechan Kang, Dong-Hun Son, Wonsoo Lee, Young-Sup Kwak, Youngseok Ohk, Boram J Korean Neurosurg Soc Clinical Article OBJECTIVE: While the risk of aneurysmal rebleeding induced by catheter cerebral angiography is a serious concern and can delay angiography for a few hours after a subarachnoid hemorrhage (SAH), current angiographic technology and techniques have been much improved. Therefore, this study investigated the risk of aneurysmal rebleeding when using a recent angiographic technique immediately after SAH. METHODS: Patients with acute SAH underwent immediate catheter angiography on admission. A four-vessel examination was conducted using a biplane digital subtraction angiography (DSA) system that applied a low injection rate and small volume of a diluted contrast, along with appropriate control of hypertension. Intra-angiographic aneurysmal rebleeding was diagnosed in cases of extravasation of the contrast medium during angiography or increased intracranial bleeding evident in flat-panel detector computed tomography scans. RESULTS: In-hospital recurrent hemorrhages before definitive treatment to obliterate the ruptured aneurysm occurred in 11 of 266 patients (4.1%). Following a univariate analysis, a multivariate analysis using a logistic regression analysis revealed that modified Fisher grade 4 was a statistically significant risk factor for an in-hospital recurrent hemorrhage (p =0.032). Cerebral angiography after SAH was performed on 88 patients ≤3 hours, 74 patients between 3–6 hours, and 104 patients >6 hours. None of the time intervals showed any cases of intra-angiographic rebleeding. Moreover, even though the DSA ≤3 hours group included more patients with a poor clinical grade and modified Fisher grade 4, no case of aneurysmal rebleeding occurred during erebral angiography. CONCLUSION: Despite the high risk of aneurysmal rebleeding within a few hours after SAH, emergency cerebral angiography after SAH can be acceptable without increasing the risk of intra-angiographic rebleeding when using current angiographic techniques and equipment. Korean Neurosurgical Society 2019-09 2019-08-30 /pmc/articles/PMC6732357/ /pubmed/31484228 http://dx.doi.org/10.3340/jkns.2018.0238 Text en Copyright © 2019 The Korean Neurosurgical Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Article
An, Hong
Park, Jaechan
Kang, Dong-Hun
Son, Wonsoo
Lee, Young-Sup
Kwak, Youngseok
Ohk, Boram
Should Cerebral Angiography Be Avoided within Three Hours after Subarachnoid Hemorrhage?
title Should Cerebral Angiography Be Avoided within Three Hours after Subarachnoid Hemorrhage?
title_full Should Cerebral Angiography Be Avoided within Three Hours after Subarachnoid Hemorrhage?
title_fullStr Should Cerebral Angiography Be Avoided within Three Hours after Subarachnoid Hemorrhage?
title_full_unstemmed Should Cerebral Angiography Be Avoided within Three Hours after Subarachnoid Hemorrhage?
title_short Should Cerebral Angiography Be Avoided within Three Hours after Subarachnoid Hemorrhage?
title_sort should cerebral angiography be avoided within three hours after subarachnoid hemorrhage?
topic Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732357/
https://www.ncbi.nlm.nih.gov/pubmed/31484228
http://dx.doi.org/10.3340/jkns.2018.0238
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