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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Benefit of 3D rotational angiography compared to conventional biplanar DSA in detecting bleeding sources after SAH

Meeting Abstract

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  • Adrian Ringelstein - Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen
  • Oliver Mueller - Neurochirurgische Klinik, Universitätsklinikum Essen
  • Sophia L. Goericke - Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen
  • Christoph Moenninghoff - Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen
  • Ulrich Sure - Neurochirurgische Klinik, Universitätsklinikum Essen
  • Michael Forsting - Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen
  • Marc Schlamann - Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMI.11.05

doi: 10.3205/13dgnc370, urn:nbn:de:0183-13dgnc3706

Published: May 21, 2013

© 2013 Ringelstein et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: In about 85% of patients with SAH a causative vascular lesions can be found during acute imaging diagnostics with CTA and DSA. In 15% the bleeding source cannot be cleared. Usually, a repetitive DSA is mandatory and includes the usual complication risk of an invasive angiography. The present study assesses if 3D rotational angiography may help to avoid a repetitive DSA.

Method: From 2004 till 2012 we extracted 90 patients with acute non-traumatic SAH and negative initial imaging diagnostics concerning the bleeding source from our PACS system. All patients have received a second angiography on the basis of an interdisciplinary neuroradiological and neurosurgical conference. Retrospective and independent double reading was performed. From 2004 till July 2008 only 2D DSA was available, since July 2008 till today 3D rotational DSA has been performed in every case during first and second DSA.

Results: In the second DSA, we found 4 aneurysms in 4 patients (4/90; 4.5%) that were treated subsequently. During the first 4.5 years of this study 60 patients needed a reangiography compared to 30 patients during the last 4.5 years. The number of patients with acute non-traumatic SAH treated in our hospital did not change significantly. During the first phase we found 3 aneurysms, during the second phase of the study only one.

Conclusions: Using 3D rotational DSA during initial imaging diagnostics helps to reduce false negative results concerning the bleeding source during acute diagnostics and helps to avoid repetitive DSA. The usage of 3D DSA during second angiography does not reveal more aneurysms than conventional biplanar DSA. 3D rotational DSA should be an essential part of diagnostics after acute SAH.