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P.107 How often does digital subtraction angiography change management in CT angiogram negative subarachnoid hemorrhages?

Published online by Cambridge University Press:  24 May 2024

K Ong
Affiliation:
(Vancouver)*
M Rizzuto
Affiliation:
(Vancouver)
K Dhillon
Affiliation:
(Vancouver)
A Sekhon
Affiliation:
(Vancouver)
M Fatehi
Affiliation:
(Vancouver)
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Abstract

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Background: Subarachnoid hemorrhages (SAH) are emergencies that require expedient workup. While Aneurysms and vascular malformations are a common cause, a subset of cases may lack detectable structural causes. If a CT angiogram (CTA) is negative, the more invasive Digital Subtraction Angiogram (DSA) is used for diagnosis. It is unclear how often DSA alters treatment for CTA negative SAHs. Methods: A retrospective review of SAH patients from our institution (Vancouver General Hospital) with a negative CTA with subsequent DSA in the past 25 years. Results: Our preliminary analysis included 233 patients. The median age was 55. 105 (45%) were female, and 128 (55%) were male. The average length of hospitalization was 9.6 days, and 226 (97%) were discharged alive. The median number of CTAs and DSAs administered were 2 and 1 respectively. In 12 (5%) cases, DSA detected an abnormality not seen on CTA, which led to endovascular or open surgery treatment in 5 (2%) cases. 5 DSA procedures led to complications including transient neurologic changes and ischemia. Conclusions: In SAH patients with CTA negative scans, additional DSA testing identified actionable pathology in only a small minority of cases. Clinicians must weigh the benefit of DSAs in these cases.

Type
Abstracts
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation