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Therapeutic decision and management of aneurysmal subarachnoid haemorrhage based on computed tomographic angiography.
Br J Neurosurg. 2003 Feb; 17(1):46-53.BJ

Abstract

The purpose of this study was to evaluate the potential of high quality computed tomographic angiography (CTA) to replace digital subtraction angiography (DSA) in cases of ruptured saccular aneurysms and perform early surgical clipping or coiling on the basis of CTA alone. In a prospective study, 100 patients with aneurysmal subarachnoid haemorrhage (SAH) diagnosed by computed tomography underwent CTA. CTA revealed a total of 118 aneurysms including all ruptured aneurysms. A decision of direct surgical clipping, endovascular coiling or therapeutic abstention was made in 89 cases (89%) on the basis of CTA alone. Sixty-one direct surgical procedures were performed after CTA. Twenty-six cases underwent DSA for immediate endovascular treatment of the ruptured aneurysm. In 11 cases (11%), a DSA was performed prior to the therapeutic decision because of unclear aneurysm. Four cases were not treated because of initial poor clinical grade. The surgical findings were compared with CTA data and were considered accurate in all but one case. All patients underwent postoperative DSA within 10 days after SAH. The sensitivity and the specificity of CTA for the detection of all aneurysms, as compared with postoperative DSA, were 95.1 and 100%, respectively. A total of six unruptured aneurysms were missed initially, but were visible retrospectively on CTA in all but one case and were found in patients with multiple aneurysms in whom the ruptured aneurysm was detected by CTA. Current quality CTA allows reliable pretreatment planning for the majority of cases of aneurysmal subarachnoid haemorrhage and diminishes the pretreatment evaluation time critically. Complementary pretreatment DSA is required in situations where CTA characteristics of the ruptured aneurysm is unsatisfactory.

Authors+Show Affiliations

Dehdashti AR
Department of Neurosurgery, Hopitaux Universitaires de Genève, Geneva, Switzerland. ardi@hcuge.ch
Rufenacht DA
No affiliation info available
Delavelle J
No affiliation info available
Reverdin A
No affiliation info available
de Tribolet N
No affiliation info available

MeSH

Aneurysm, RupturedAngiography, Digital SubtractionCerebral AngiographyDecision MakingHematoma, SubduralHumansIntracranial AneurysmMaleMiddle AgedNeurosurgical ProceduresProspective StudiesSensitivity and SpecificitySubarachnoid HemorrhageTomography, X-Ray ComputedTreatment Outcome

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

12779201

Citation

Dehdashti, A R., et al. "Therapeutic Decision and Management of Aneurysmal Subarachnoid Haemorrhage Based On Computed Tomographic Angiography." British Journal of Neurosurgery, vol. 17, no. 1, 2003, pp. 46-53.
Dehdashti AR, Rufenacht DA, Delavelle J, et al. Therapeutic decision and management of aneurysmal subarachnoid haemorrhage based on computed tomographic angiography. Br J Neurosurg. 2003;17(1):46-53.
Dehdashti, A. R., Rufenacht, D. A., Delavelle, J., Reverdin, A., & de Tribolet, N. (2003). Therapeutic decision and management of aneurysmal subarachnoid haemorrhage based on computed tomographic angiography. British Journal of Neurosurgery, 17(1), 46-53.
Dehdashti AR, et al. Therapeutic Decision and Management of Aneurysmal Subarachnoid Haemorrhage Based On Computed Tomographic Angiography. Br J Neurosurg. 2003;17(1):46-53. PubMed PMID: 12779201.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Therapeutic decision and management of aneurysmal subarachnoid haemorrhage based on computed tomographic angiography. AU - Dehdashti,A R, AU - Rufenacht,D A, AU - Delavelle,J, AU - Reverdin,A, AU - de Tribolet,N, PY - 2003/6/5/pubmed PY - 2003/6/20/medline PY - 2003/6/5/entrez SP - 46 EP - 53 JF - British journal of neurosurgery JO - Br J Neurosurg VL - 17 IS - 1 N2 - The purpose of this study was to evaluate the potential of high quality computed tomographic angiography (CTA) to replace digital subtraction angiography (DSA) in cases of ruptured saccular aneurysms and perform early surgical clipping or coiling on the basis of CTA alone. In a prospective study, 100 patients with aneurysmal subarachnoid haemorrhage (SAH) diagnosed by computed tomography underwent CTA. CTA revealed a total of 118 aneurysms including all ruptured aneurysms. A decision of direct surgical clipping, endovascular coiling or therapeutic abstention was made in 89 cases (89%) on the basis of CTA alone. Sixty-one direct surgical procedures were performed after CTA. Twenty-six cases underwent DSA for immediate endovascular treatment of the ruptured aneurysm. In 11 cases (11%), a DSA was performed prior to the therapeutic decision because of unclear aneurysm. Four cases were not treated because of initial poor clinical grade. The surgical findings were compared with CTA data and were considered accurate in all but one case. All patients underwent postoperative DSA within 10 days after SAH. The sensitivity and the specificity of CTA for the detection of all aneurysms, as compared with postoperative DSA, were 95.1 and 100%, respectively. A total of six unruptured aneurysms were missed initially, but were visible retrospectively on CTA in all but one case and were found in patients with multiple aneurysms in whom the ruptured aneurysm was detected by CTA. Current quality CTA allows reliable pretreatment planning for the majority of cases of aneurysmal subarachnoid haemorrhage and diminishes the pretreatment evaluation time critically. Complementary pretreatment DSA is required in situations where CTA characteristics of the ruptured aneurysm is unsatisfactory. SN - 0268-8697 UR - https://www.unboundmedicine.com/medline/citation/12779201/Therapeutic_decision_and_management_of_aneurysmal_subarachnoid_haemorrhage_based_on_computed_tomographic_angiography_ DB - PRIME DP - Unbound Medicine ER -