What Is The Need For Repeat Angiography In Spontaneous Subarachnoid Hemorrhages With Negative Initial Angiogram?

Objective: Repeat angiography is usually performed in spontaneous SAH patients who have negative initial angiography. In this study we aimed to evaluate the yield of repeat angiography in spontaneous SAH with different clinics and bleeding paterns. Methods: A retrospective analysis was performed on spontaneous SAH patients who admitted to our neurosurgery clinic. The patients were divided into two groups as perimesencephalic and nonperimesencephalic SAH according to their bleeding patern on cerebral CT. Demographic and clinic data, routine follow-up cerebral angiography within 2 weeks, complications due to repeated cerebral angiography and the presence of new detected vascular pathology were all recorded. Results: 208 patients with spontaneous SAH with mean age 60.00±15.82 (20-83) years were included. The Fisher score was found lower in perimesencephalic SAH patients. Mortality was also seen more frequently in nonperimesencephalic SAH. In repeat angiography vascular pathology related with SAH was found in only nonperimesencephalic SAH patients without any statistically significancy (0 vs 4, p:0.078). The incidence of complications due to repeat angiography was similiar in both groups. Conclusion: In conclusion clinicians should consider to evaluate the spontaneous SAH with subsequent neuroimaging tests once more to rule out cerebral vascular pathologies. Our data suggested that perimesencephalic SAH has a better Fisher score and less mortality when compared with nonperimesencephalic SAH. Our perimesencephalic SAH patients have no vascular pathology even after repeat angiography. Therefore high quality MR angiography or CTangiography can be easily performed rather than cerebral angiography which is an invasive imaging method. Cerebral angiography should be considered only in suspected cases with perimesencephalic SAH.

İlk Anjiografisi Negatif Olan Spontan Subaraknoid Kanamalarda Anjiografi Tekrarının Gereksinimi Nedir?

Amaç: Bu çalışmanın amacı, obstetrik nedenli dissemine intravasküler kuagülasyonun (DİK) altta yatan nedenlerini araştırmak ve Giriş: Tekrar anjiografi ilk anjiografisi negatif olan spontan subaraknoid kanamalı (SAK) hastalarda genelde uygulanır. Bu çalışmada tekrar anjiografinin gerekliliğini farklı klinik ve kanama paterni olan spontan SAK’larda incelemeyi amaçladık. Yöntemler: Nöroşirurji Kliniğimize başvuran spontan SAK hasta verileri üzerinden retrospektif analiz yapıldı. Hastalar perimesensefalik ve nonperimesensefalik SAK olarak serebral BT’de kanama paternlerine göre iki gruba ayrıldı. Demografik, klinik veri, rutin iki hafta içinde uygulanan izlem serebral anjiografiler, anjiografi tekrarına bağlı komplikasyonlar ve yeni saptanan vaskuler patoloji varlığı kaydedildi. Bulgular: 208 spontan SAK hastası ortalama yaş 60.00±15.82 (20-83) dahil edildi. Fisher skoru perimesensefalik SAK hastalarında daha düşük elde edildi. Mortalite de nonperimesensefalik SAK hastalarda daha sık izlenildi. SAK ile ilişkili vaskuler patoloji sadece nonperimesensefalik SAK hastalarında istatistiksel farklılık olmaksızın izlenildi (0 vs 4, p:0.078). Anjiografi tekrarına bağlı komplikasyon insidansı her iki grupta benzerdi. Sonuç: Klinisyenler spontan SAK’ta serebral vaskuler patolojileri bir kere daha dışlamak amacıyla ardışık nörogörüntüleme testleri düşünmelidir. Verilerimiz nonperimesensefalik ile kıyaslandığında perimesensefalik SAK’larda Fisher skorunun daha iyi ve daha az mortal olduğunu desteklemektedir. Perimesensefalik SAK hastalarımızın anjiografi tekrarlarında herhangi vaskuler patoloji yoktu. Bu nedenle bu hastalarda invazif bir görüntüleme metodu olan serebral anjiografi yerine yüksek kalitede MRanjiografi veya BTanjiografi daha kolay uygulanabilir. Serebral anjiografi sadece şüphelenilen perimesensefalik SAKlarda düşünülebilir.

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