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A Multicenter Analysis of Computed Tomography Angiography Alone Versus Digital Subtraction Angiography for the Surgical Treatment of Poor-Grade Aneurysmal Subarachnoid Hemorrhage.
World Neurosurg. 2016 Jul; 91:106-11.WN

Abstract

BACKGROUND

Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is associated with increased intracranial pressure, and these patients are unstable with a high risk of rebleeding. Computed tomography angiography (CTA) has been proposed as an examination tool for the rapid detection of ruptured aneurysms. We aimed to determine the safety and efficacy of CTA alone for surgical treatment of poor-grade aSAH compared with digital subtraction angiography (DSA).

METHODS

We conducted a multicenter retrospective analysis of 144 patients with poor-grade aSAH who underwent surgical treatment for 2 different cohorts. Patients were grouped into CTA alone and DSA groups. Baseline characteristics, postoperative complications, and clinical outcomes at discharge and at last follow-up were compared between the 2 groups. Multivariate logistic regression models were used to assess the association between CTA alone and clinical outcomes after we adjusted for potential confounders.

RESULTS

Of the 116 patients included, 42 (36.2%) patents received CTA alone and 74 patients (63.7%), including 12 patients with CTA and DSA and 62 patients with DSA alone, received DSA before surgical treatment. Patients with larger ruptured aneurysms (P = 0.006), aneurysm sizes of larger than 5 mm (P = 0.025), presence of single aneurysms (P = 0.018), and presence of intraventricular hemorrhage (P = 0.019) more often received CTA alone. All ruptured aneurysms were clipped successfully during surgery. There were no statistically significant differences in postoperative complications and clinical outcomes between the 2 groups.

CONCLUSIONS

Although CTA alone can be safely and effectively used in most patients requiring surgical treatment, additional DSA may be considered in patients with smaller ruptured aneurysms or in those with multiple aneurysms.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Zhao B
Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
Lin F
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Wu J
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Zheng K
Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Tan X
Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Cao Y
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Zhao Y
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Wang S
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Electronic address: captain9858@vip.sina.com.
Zhong M
Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. Electronic address: zhongming158@sohu.com.

MeSH

AdultAgedAneurysm, RupturedAngiography, Digital SubtractionCerebral HemorrhageComputed Tomography AngiographyFemaleHumansIntracranial AneurysmMaleMiddle AgedOutcome Assessment, Health CareRetrospective StudiesSubarachnoid HemorrhageYoung Adult

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

27060510

Citation

Zhao, Bing, et al. "A Multicenter Analysis of Computed Tomography Angiography Alone Versus Digital Subtraction Angiography for the Surgical Treatment of Poor-Grade Aneurysmal Subarachnoid Hemorrhage." World Neurosurgery, vol. 91, 2016, pp. 106-11.
Zhao B, Lin F, Wu J, et al. A Multicenter Analysis of Computed Tomography Angiography Alone Versus Digital Subtraction Angiography for the Surgical Treatment of Poor-Grade Aneurysmal Subarachnoid Hemorrhage. World Neurosurg. 2016;91:106-11.
Zhao, B., Lin, F., Wu, J., Zheng, K., Tan, X., Cao, Y., Zhao, Y., Wang, S., & Zhong, M. (2016). A Multicenter Analysis of Computed Tomography Angiography Alone Versus Digital Subtraction Angiography for the Surgical Treatment of Poor-Grade Aneurysmal Subarachnoid Hemorrhage. World Neurosurgery, 91, 106-11. https://doi.org/10.1016/j.wneu.2016.03.099
Zhao B, et al. A Multicenter Analysis of Computed Tomography Angiography Alone Versus Digital Subtraction Angiography for the Surgical Treatment of Poor-Grade Aneurysmal Subarachnoid Hemorrhage. World Neurosurg. 2016;91:106-11. PubMed PMID: 27060510.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Multicenter Analysis of Computed Tomography Angiography Alone Versus Digital Subtraction Angiography for the Surgical Treatment of Poor-Grade Aneurysmal Subarachnoid Hemorrhage. AU - Zhao,Bing, AU - Lin,Fuxin, AU - Wu,Jun, AU - Zheng,Kuang, AU - Tan,Xianxi, AU - Cao,Yong, AU - Zhao,Yuanli, AU - Wang,Shuo, AU - Zhong,Ming, Y1 - 2016/04/06/ PY - 2016/02/03/received PY - 2016/03/29/revised PY - 2016/03/30/accepted PY - 2016/4/10/entrez PY - 2016/4/10/pubmed PY - 2017/9/9/medline KW - CT angiography KW - Complications KW - Intracranial aneurysms KW - Outcomes KW - Poor-grade KW - Subarachnoid hemorrhage KW - Surgery SP - 106 EP - 11 JF - World neurosurgery JO - World Neurosurg VL - 91 N2 - BACKGROUND: Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is associated with increased intracranial pressure, and these patients are unstable with a high risk of rebleeding. Computed tomography angiography (CTA) has been proposed as an examination tool for the rapid detection of ruptured aneurysms. We aimed to determine the safety and efficacy of CTA alone for surgical treatment of poor-grade aSAH compared with digital subtraction angiography (DSA). METHODS: We conducted a multicenter retrospective analysis of 144 patients with poor-grade aSAH who underwent surgical treatment for 2 different cohorts. Patients were grouped into CTA alone and DSA groups. Baseline characteristics, postoperative complications, and clinical outcomes at discharge and at last follow-up were compared between the 2 groups. Multivariate logistic regression models were used to assess the association between CTA alone and clinical outcomes after we adjusted for potential confounders. RESULTS: Of the 116 patients included, 42 (36.2%) patents received CTA alone and 74 patients (63.7%), including 12 patients with CTA and DSA and 62 patients with DSA alone, received DSA before surgical treatment. Patients with larger ruptured aneurysms (P = 0.006), aneurysm sizes of larger than 5 mm (P = 0.025), presence of single aneurysms (P = 0.018), and presence of intraventricular hemorrhage (P = 0.019) more often received CTA alone. All ruptured aneurysms were clipped successfully during surgery. There were no statistically significant differences in postoperative complications and clinical outcomes between the 2 groups. CONCLUSIONS: Although CTA alone can be safely and effectively used in most patients requiring surgical treatment, additional DSA may be considered in patients with smaller ruptured aneurysms or in those with multiple aneurysms. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/27060510/A_Multicenter_Analysis_of_Computed_Tomography_Angiography_Alone_Versus_Digital_Subtraction_Angiography_for_the_Surgical_Treatment_of_Poor_Grade_Aneurysmal_Subarachnoid_Hemorrhage_ DB - PRIME DP - Unbound Medicine ER -