Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Should Cerebral Angiography Be Avoided within Three Hours after Subarachnoid Hemorrhage?

  • 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)
  • Received : 2018.12.24
  • Accepted : 2019.05.09
  • Published : 2019.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

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.

Keywords

References

  1. Allan DM, Witcombe JB : Intracranial extravasation of contrast medium during carotid angiography. Br J Radiol 50 : 404-411, 1977 https://doi.org/10.1259/0007-1285-50-594-404
  2. Amagasa M, Yoshimoto T, Mizoi K, Suzuki J : Early cerebral angiography after aneurysm rupture. Analysis of 197 cases. J Neurosurg 65 : 776-778, 1986 https://doi.org/10.3171/jns.1986.65.6.0776
  3. Aoyagi N, Hayakawa I : Rerupture of intracranial aneurysms during angiography. Acta Neurochir (Wien) 98 : 141-147, 1989 https://doi.org/10.1007/BF01407340
  4. Boogaarts HD, van Lieshout JH, van Amerongen MJ, de Vries J, Verbeek AL, Grotenhuis JA, et al. : Aneurysm diameter as a risk factor for pretreatment rebleeding: a meta-analysis. J Neurosurg 122 : 921-928, 2015 https://doi.org/10.3171/2014.12.JNS14931
  5. Cha KC, Kim JH, Kang HI, Moon BG, Lee SJ, Kim JS : Aneurysmal rebleeding: factors associated with clinical outcome in the rebleeding patients. J Korean Neurosurg Soc 47 : 119-123, 2010 https://doi.org/10.3340/jkns.2010.47.2.119
  6. Clarencon F, Piotin M, Pistocchi S, Babic D, Blanc R : Evaluation of stent visibility by flat panel detector CT in patients treated for intracranial aneurysms. Neuroradiology 54 : 1121-1125, 2012 https://doi.org/10.1007/s00234-011-1002-8
  7. Fujii Y, Takeuchi S, Sasaki O, Minakawa T, Koike T, Tanaka R : Ultraearly rebleeding in spontaneous subarachnoid hemorrhage. J Neurosurg 84 : 35-42, 1996 https://doi.org/10.3171/jns.1996.84.1.0035
  8. Guo LM, Zhou HY, Xu JW, Wang Y, Qiu YM, Jiang JY : Risk factors related to aneurysmal rebleeding. World Neurosurg 76 : 292-298; discussion 253-254, 2011 https://doi.org/10.1016/j.wneu.2011.03.025
  9. Hillman J, Fridriksson S, Nilsson O, Yu Z, Saveland H, Jakobsson KE : Immediate administration of tranexamic acid and reduced incidence of early rebleeding after aneurysmal subarachnoid hemorrhage: a prospective randomized study. J Neurosurg 97 : 771-778, 2002 https://doi.org/10.3171/jns.2002.97.4.0771
  10. Inagawa T : Ultra-early rebleeding within six hours after aneurysmal rupture. Surg Neurol 42 : 130-134, 1994 https://doi.org/10.1016/0090-3019(94)90373-5
  11. Inagawa T, Kamiya K, Ogasawara H, Yano T : Rebleeding of ruptured intracranial aneurysms in the acute stage. Surg Neurol 28 : 93-99, 1987 https://doi.org/10.1016/0090-3019(87)90079-6
  12. Jane JA, Kassell NF, Torner JC, Winn HR : The natural history of aneurysms and arteriovenous malformations. J Neurosurg 62 : 321-323, 1985 https://doi.org/10.3171/jns.1985.62.3.0321
  13. Juvela S : Rebleeding from ruptured intracranial aneurysms. Surg Neurol 32 : 323-326, 1989 https://doi.org/10.1016/0090-3019(89)90133-X
  14. Kassell NF, Torner JC : Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery 13 : 479-481, 1983 https://doi.org/10.1227/00006123-198311000-00001
  15. Koenig GH, Marshall WH Jr, Poole GJ, Kramer RA : Rupture of intracranial aneurysms during cerebral angiography: report of ten cases and review of the literature. Neurosurgery 5 : 314-324, 1979 https://doi.org/10.1227/00006123-197909000-00003
  16. Komiyama M, Tamura K, Nagata Y, Fu Y, Yagura H, Yasui T : Aneurysmal rupture during angiography. Neurosurgery 33 : 798-803, 1993 https://doi.org/10.1227/00006123-199311000-00002
  17. Kusumi M, Yamada M, Kitahara T, Endo M, Kan S, Iida H, et al. : Rerupture of cerebral aneurysms during angiography--a retrospective study of 13 patients with subarachnoid hemorrhage. Acta Neurochir (Wien) 147 : 831-837, 2005 https://doi.org/10.1007/s00701-005-0541-3
  18. Laidlaw JD, Siu KH : Poor-grade aneurysmal subarachnoid hemorrhage: outcome after treatment with urgent surgery. Neurosurgery 53 : 1275-1280; discussion 1280-1282, 2003 https://doi.org/10.1227/01.NEU.0000093199.74960.FF
  19. Ohkuma H, Tsurutani H, Suzuki S : Incidence and significance of early aneurysmal rebleeding before neurosurgical or neurological management. Stroke 32 : 1176-1180, 2001 https://doi.org/10.1161/01.STR.32.5.1176
  20. Park J, Woo H, Kang DH, Kim YS, Kim MY, Shin IH, et al. : Formal protocol for emergency treatment of ruptured intracranial aneurysms to reduce in-hospital rebleeding and improve clinical outcomes. J Neurosurg 122 : 383-391, 2015 https://doi.org/10.3171/2014.9.JNS131784
  21. Park SD, Kim JH, Chang CH, Jung YJ : Procedure-related complication rate for the endovascular treatment of aneurysmal subarachnoid hemorrhage under local anesthesia. J Cerebrovasc Endovasc Neurosurg 18 : 215-222, 2016 https://doi.org/10.7461/jcen.2016.18.3.215
  22. Saitoh H, Hayakawa K, Nishimura K, Okuno Y, Murayama C, Miyazawa T, et al. : Intracarotid blood pressure changes during contrast medium injection. AJNR Am J Neuroradiol 17 : 51-54, 1996
  23. Saitoh H, Hayakawa K, Nishimura K, Okuno Y, Teraura T, Yumitori K, et al. : Rerupture of cerebral aneurysms during angiography. AJNR Am J Neuroradiol 16 : 539-542, 1995
  24. Sampei T, Yasui N, Mizuno M, Nakajima S, Ishikawa T, Hadeishi H, et al. : Contrast medium extravasation during cerebral angiography for ruptured intracranial aneurysm--clinical analysis of 26 cases. Neurol Med Chir (Tokyo) 30 : 1011-1015, 1990 https://doi.org/10.2176/nmc.30.1011
  25. Soderman M, Babic D, Holmin S, Andersson T : Brain imaging with a flat detector C-arm : technique and clinical interest of XperCT. Neuroradiology 50 : 863-868, 2008 https://doi.org/10.1007/s00234-008-0419-1
  26. Sorimachi T, Takeuchi S, Koike T, Minakawa T, Tanaka R : Intra-aneurysmal pressure changes during angiography in coil embolization. Surg Neurol 48 : 451-457, 1997 https://doi.org/10.1016/S0090-3019(97)00278-4
  27. Tsementzis SA, Kennett RP, Hitchcock ER : Rupture of intracranial vascular lesions during arteriography. J Neurol Neurosurg Psychiatry 47 : 795-798, 1984 https://doi.org/10.1136/jnnp.47.8.795
  28. Waldenberger P, Chemelli A, Mallouhi A : Intra-arterial haemodynamic changes during cerebral three-dimensional rotational angiography. Eur Radiol 19 : 503-508, 2009 https://doi.org/10.1007/s00330-008-1161-0
  29. Yuguang L, Tao J, Meng L, Shugan Z, Jiangang W, Yang Y, et al. : Rerupture of intracranial aneurysms during cerebral angiography. J Clin Neurosci 10 : 674-676, 2003 https://doi.org/10.1016/j.jocn.2002.08.001
  30. Zaehringer M, Wedekind C, Gossmann A, Krueger K, Trenschel G, Landwehr P : Aneurysmal re-rupture during selective cerebral angiography. Eur Radiol 12 Suppl 3 : S18-S24, 2002 https://doi.org/10.1007/s00330-002-1460-9

Cited by

  1. Hematoma expansion unrelated to rebleeding in ruptured anterior cerebral artery aneurysms treated by early endovascular embolization vol.12, 2021, https://doi.org/10.25259/sni_816_2021
  2. An in vitro study of pressure increases during contrast injections in diagnostic cerebral angiography vol.27, pp.5, 2019, https://doi.org/10.1177/1591019921996099