Selective angiography for early aneurysm detection in acute subarachnoid haemorrhage

In a consecutive series of 312 surgical aneurysm cases more than 90% of the patients reached neurosurgical expertise within 48 hours from bleeding. Computed tomography permitted prediction of the assumed rupture site based on blood clot location in the majority (86%) of cases. This target vascular territory was usually investigated by selective angiography and in 9 out of 10 patients an aneurysm, ultimately shown to be the correct source of bleeding, was demonstrated. In 14% of the cases the source of bleeding could not be established thus calling for complete four vessel studies. It is concluded that limited angiographic studies are compatible with preserving a high surgical standard in cases unequivocally exhibiting a localizing clot pattern on the CT scan. Though suboptimal in a general sense, incomplete vascular studies, if four vessel angiography is not obtainable without delay or risk, should not delay earliest possible clipping of ruptured aneurysms to avoid the devastating effects of recurrent bleeds.