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The Rabbit Blood-shunt Model for the Study of Acute and Late Sequelae of Subarachnoid Hemorrhage: Technical Aspects
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3D Rotational Angiography After Non-Traumatic SAH
A Ringelstein1, O Mueller2, C Mönninghoff1
1Department of Diagnostic and Interventional Radiology and Neuroradiology, Univ. Duisburg-Essen, Medical Faculty, Essen.
Insights
Three-dimensional rotational angiography may reduce the need for repeat digital subtraction angiography (DSA) in patients with subarachnoid hemorrhage (SAH) by improving initial diagnostic accuracy. This technique offers higher diagnostic security for identifying causative vascular lesions.
Area of Science:
- Neurology
- Radiology
- Vascular Surgery
Background:
- Subarachnoid hemorrhage (SAH) diagnosis often requires identifying causative vascular lesions.
- Conventional imaging like CTA and DSA may fail to detect lesions in up to 15% of SAH patients.
- Repeat DSA is typically necessary but carries risks associated with invasive angiography.
Purpose of the Study:
- To evaluate the diagnostic impact of 3D rotational angiography in identifying vascular lesions in SAH patients.
- To determine if 3D rotational angiography can reduce the need for repeat digital subtraction angiography (DSA).
- To assess the diagnostic yield of 3D rotational angiography compared to conventional techniques.
Main Methods:
- A retrospective study of 649 patients with acute non-traumatic SAH from 2004-2012.
- Included 91 patients with negative initial imaging who underwent repeat angiography.
- Compared conventional 4-plane DSA (n=61) with 2-plane DSA plus 3D rotational angiography (n=30).
Main Results:
- Repeat angiography identified aneurysms in 4.4% of patients (4/91).
- The 3D rotational angiography group showed a trend towards higher diagnostic security, although not statistically significant (p=0.29).
- Fewer patients underwent repeat angiography in the 3D DSA era (12.1%) compared to the conventional DSA era (15.2%).
Conclusions:
- Three-dimensional rotational DSA may improve the detection of vascular lesions in acute SAH.
- Incorporating 3D rotational DSA into the initial workup could reduce false-negative findings.
- This technique may help minimize the need for repeat invasive procedures in SAH management.
Purpose:
In about 15 % of patients with SAH no causative vascular lesions can be found in acute imaging with CTA and DSA. Usually, repeat DSA is mandatory and bears the usual risk of invasive angiography. The present study attempts to assess the diagnostic impact of 3 D rotational angiography in order to avoid repeat DSA.
Materials And Methods:
From January 2004 to December 2012, 649 patients with an acute non-traumatic SAH were examined. 91 patients with negative initial imaging diagnostics concerning the bleeding source were included in this study. These patients underwent a second angiography scan: 61 in 4-plane technique, and 30 with 2-plane technique and additional 3 D DSA. Two cohorts were compared: patients with repeat angiography in conventional 4-plane technique from 2004 to July 2008 and 2-plane technique with additional 3 D rotational DSA from 2008 to 2012. Statistical significance was verified by means of Fisher's exact test.
Results:
In the second DSA scan, 4 aneurysms in 4 patients (4/91; 4.4 %) were found and treated subsequently. Within the first 4.5 years of this study, 401 patients with SAH were treated and 61 of them underwent repeat angiography (15.2 %) compared to 30 of 248 patients (12.1 %) in the last 4.5 years of this study. In the first group we found 3 aneurysms during repeat angiography, and in the second group we found 1. No significance was reached (p = 0.29) but there was a tendency towards higher diagnostic security using 3D-DSA.
Conclusion:
Using 3 D rotational DSA in initial imaging workup might help to reduce false-negative results concerning the bleeding source of acute SAH. At least because of this fact, 3 D rotational DSA should be part of the diagnostic workup after acute SAH.
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