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

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자료유형: 학술저널

저자정보: An, Hong (Department of Neurosurgery, School of Medicine, Kyungpook National University) Park, Jaechan (Department of Neurosurgery, School of Medicine, Kyungpook National University) Kang, Dong-Hun (Department of Neurosurgery, School of Medicine, Kyungpook National University) Son, Wonsoo (Department of Neurosurgery, School of Medicine, Kyungpook National University) Lee, Young-Sup (Department of Neurosurgery, School of Medicine, Kyungpook National University) Kwak, Youngseok (Department of Neurosurgery, School of Medicine, Catholic University of Daegu) Ohk, Boram (Clinical Trial Center, Kyungpook National University Hospital)

저널정보: 대한신경외과학회 대한신경외과학회지 대한신경외과학회지 제62권 제5호

발행연도: 2019.1

수록면: 526 - 535 (10page)

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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 ${\leq}3$ 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 ${\leq}3$ 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.

#Aneurysm, Ruptured #Angiography #Intracranial aneurysm #Subarachnoid hemorrhage

참고문헌 (30)

참고문헌 신청

Allan DM / 1977 / Intracranial extravasation of contrast medium during carotid angiography / Br J Radiol 50:404~411

Amagasa M / 1986 / Early cerebral angiography after aneurysm rupture. Analysis of 197 cases / J Neurosurg 65:776~778

Aoyagi N / 1989 / Rerupture of intracranial aneurysms during angiography / Acta Neurochir (Wien) 98:141~147

Boogaarts HD / 2015 / Aneurysm diameter as a risk factor for pretreatment rebleeding: a meta-analysis / J Neurosurg 122:921~928

Ki Chul Cha, / 2010 / Aneurysmal Rebleeding : Factors Associated with Clinical Outcome in the Rebleeding Patients / 대한신경외과학회지 47(2):119~123

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