3D Rotational Angiography After Non-Traumatic SAH

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.