Repeat digital subtraction angiography after a negative baseline assessment in nonperimesencephalic subarachnoid hemorrhage: a pooled data meta-analysis

A systematic review

Restricted access

Object

A repeat digital subtraction angiography (DSA) study of the cranial vasculature is routinely performed in patients with diffuse nonperimesencephalic subarachnoid hemorrhage (SAH) after negative baseline CT angiography (CTA) and DSA studies. However, DSA carries a low but substantial risk of neurological complications. Therefore, the authors evaluated the added value of repeat DSA in patients with initial angiographically negative diffuse nonperimesencephalic SAH.

Methods

A systematic review of the contemporary literature was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Studies from January 2000 onward were reviewed since imaging modalities have much improved over the last decade. A pooled analysis was conducted to identify the detection rate of repeat DSA. In addition, the diagnostic yield of repeat DSAs in a prospectively maintained single-center series of 1051 consecutive patients with SAH was added to the analysis.

Results

An initial search of the literature yielded 179 studies, 8 of which met the selection criteria. Another 45 patients from the authors' institution were included in the study, providing 368 patients eligible for the pooled analysis. In 37 patients (10.0%, 95% CI 7.4%–13.6%) an aneurysm was detected on repeat DSA. The timing of the repeat DSA varied from 1 to 6 weeks after the initial DSA. The use of 3D techniques was poorly described among these studies, and no direct comparisons between CTA and DSA were made.

Conclusions

Repeat DSA is still warranted in patients with a diffuse nonperimesencephalic SAH and negative initial assessment. However, the exact timing of the repeat DSA is subject to debate.

Abbreviations used in this paper:CTA = CT angiography; DSA = digital subtraction angiography; MRA = MR angiography; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SAH = subarachnoid hemorrhage.
Article Information

Contributor Notes

Address correspondence to: Nicolaas A. Bakker, M.D., Ph.D., Department of Neurosurgery AB71, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. email: n.a.bakker@umcg.nl.Please include this information when citing this paper: published online October 25, 2013; DOI: 10.3171/2013.9.JNS131337.

© AANS, except where prohibited by US copyright law.

Headings
References
  • 1

    Agid RAndersson TAlmqvist HWillinsky RALee SKterBrugge KG: Negative CT angiography findings in patients with spontaneous subarachnoid hemorrhage: When is digital subtraction angiography still needed?. AJNR Am J Neuroradiol 31:6967052010

    • Search Google Scholar
    • Export Citation
  • 2

    Andaluz NZuccarello M: Yield of further diagnostic workup of cryptogenic subarachnoid hemorrhage based on bleeding patterns on computed tomographic scans. Neurosurgery 62:104010472008

    • Search Google Scholar
    • Export Citation
  • 3

    Cloft HJJoseph GJDion JE: Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation: a meta-analysis. Stroke 30:3173201999

    • Search Google Scholar
    • Export Citation
  • 4

    Cruz JPSarma DNoel de Tilly L: Perimesencephalic subarachnoid hemorrhage: when to stop imaging?. Emerg Radiol 18:1972022011

  • 5

    Dalyai RChalouhi NTheofanis TJabbour PMDumont ASGonzalez LF: Subarachnoid hemorrhage with negative initial catheter angiography: a review of 254 cases evaluating patient clinical outcome and efficacy of short- and long-term repeat angiography. Neurosurgery 72:6466522013

    • Search Google Scholar
    • Export Citation
  • 6

    Delgado Almandoz JEJagadeesan BDRefai DMoran CJCross DT IIIChicoine MR: Diagnostic yield of computed tomography angiography and magnetic resonance angiography in patients with catheter angiography-negative subarachnoid hemorrhage. Clinical article. J Neurosurg 117:3093152012

    • Search Google Scholar
    • Export Citation
  • 7

    Delgado Almandoz JEJagadeesan BDRefai DMoran CJCross DT IIIChicoine MR: Diagnostic yield of repeat catheter angiography in patients with catheter and computed tomography angiography negative subarachnoid hemorrhage. Neurosurgery 70:113511422012

    • Search Google Scholar
    • Export Citation
  • 8

    Grzyska UFreitag JZeumer H: Selective cerebral intraarterial DSA. Complication rate and control of risk factors. Neuroradiology 32:2962991990

    • Search Google Scholar
    • Export Citation
  • 9

    Huttner HBHartmann MKöhrmann MNeher MStippich CHähnel S: Repeated digital substraction angiography after perimesencephalic subarachnoid hemorrhage?. J Neuroradiol 33:87892006

    • Search Google Scholar
    • Export Citation
  • 10

    Iwanaga HWakai SOchiai CNarita JInoh SNagai M: Ruptured cerebral aneurysms missed by initial angiographic study. Neurosurgery 27:45511990

    • Search Google Scholar
    • Export Citation
  • 11

    Jung JYKim YBLee JWHuh SKLee KC: Spontaneous subarachnoid haemorrhage with negative initial angiography: a review of 143 cases. J Clin Neurosci 13:101110172006

    • Search Google Scholar
    • Export Citation
  • 12

    Kershenovich ARappaport ZHMaimon S: Brain computed tomography angiographic scans as the sole diagnostic examination for excluding aneurysms in patients with perimesencephalic subarachnoid hemorrhage. Neurosurgery 59:7988022006

    • Search Google Scholar
    • Export Citation
  • 13

    Khan AASmith JDKirkman MARobertson FJWong KDott C: Angiogram negative subarachnoid haemorrhage: outcomes and the role of repeat angiography. Clin Neurol Neurosurg 115:147014752013

    • Search Google Scholar
    • Export Citation
  • 14

    Lasjaunias PChiu Mter Brugge KTolia AHurth MBernstein M: Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg 64:7247301986

    • Search Google Scholar
    • Export Citation
  • 15

    Little ASGarrett MGermain RFarhataziz NAlbuquerque FCMcDougall CG: Evaluation of patients with spontaneous subarachnoid hemorrhage and negative angiography. Neurosurgery 61:113911512007

    • Search Google Scholar
    • Export Citation
  • 16

    Prestigiacomo CJSabit AHe WJethwa PGandhi CRussin J: Three dimensional CT angiography versus digital subtraction angiography in the detection of intracranial aneurysms in subarachnoid hemorrhage. J Neurointerv Surg 2:3853892010

    • Search Google Scholar
    • Export Citation
  • 17

    Rinkel GJWijdicks EFHasan DKienstra GEFranke CLHageman LM: Outcome in patients with subarachnoid haemorrhage and negative angiography according to pattern of haemorrhage on computed tomography. Lancet 338:9649681991

    • Search Google Scholar
    • Export Citation
  • 18

    Rogg JMSmeaton SDoberstein CGoldstein JHTung GAHaas RA: Assessment of the value of MR imaging for examining patients with angiographically negative subarachnoid hemorrhage. AJR Am J Roentgenol 172:2012061999

    • Search Google Scholar
    • Export Citation
  • 19

    Topcuoglu MAOgilvy CSCarter BSBuonanno FSKoroshetz WJSinghal AB: Subarachnoid hemorrhage without evident cause on initial angiography studies: diagnostic yield of subsequent angiography and other neuroimaging tests. J Neurosurg 98:123512402003

    • Search Google Scholar
    • Export Citation
  • 20

    Westerlaan HEGravendeel JFiore DMetzemaekers JDGroen RJMooij JJ: Multislice CT angiography in the selection of patients with ruptured intracranial aneurysms suitable for clipping or coiling. Neuroradiology 49:99710072007

    • Search Google Scholar
    • Export Citation
  • 21

    Westerlaan HEvan Dijk JMJansen-van der Weide MCde Groot JCGroen RJMooij JJ: Intracranial aneurysms in patients with subarachnoid hemorrhage: CT angiography as a primary examination tool for diagnosis—systematic review and meta-analysis. Radiology 258:1341452011. (Erratum in Radiology 260: 612 2011)

    • Search Google Scholar
    • Export Citation
  • 22

    Willinsky RATaylor SMTerBrugge KFarb RITomlinson GMontanera W: Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology 227:5225282003

    • Search Google Scholar
    • Export Citation
  • 23

    Yu DWJung YJChoi BYChang CH: Subarachnoid hemorrhage with negative baseline digital subtraction angiography: is repeat digital subtraction angiography necessary?. J Cerebrovasc Endovasc Neurosurg 14:2102152012

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 696 596 114
PDF Downloads 310 217 13
EPUB Downloads 0 0 0
PubMed
Google Scholar