Catheter Angiogram-Negative Subarachnoid Hemorrhage: Delayed Cerebral Ischemia, Shunt Dependency, and Diagnostic Yield of Serial Angiography.
Repeat cerebral angiography after negative initial workup found new lesions in only 3.9%
Catheter Angiogram-Negative Subarachnoid Hemorrhage: Delayed Cerebral Ischemia, Shunt Dependency, and Diagnostic Yield of Serial Angiography.
Initial cerebral angiogram-negative subarachnoid hemorrhage (subarachnoid hemorrhage) represents approximately 10% of spontaneous subarachnoid hemorrhage cases.
The objectives of this study were to determine the diagnostic yield of repeat angiography (beyond the index angiogram) and the rates of delayed cerebral ischemia (delayed cerebral ischemia) and hydrocephalus in this population.
A retrospective cohort study of patients with an initial negative angiogram after presenting with subarachnoid hemorrhage between January 2020 and December 2024 was performed using data derived from a prospectively maintained database of patients with subarachnoid hemorrhage (computed tomography- or lumbar puncture-proven) at a single institution.
Cluster analysis identified 3 clusters: noncisternal subarachnoid hemorrhage; perimesencephalic subarachnoid hemorrhage, and diffuse subarachnoid hemorrhage.
Overall, 3 patients (1.5%) developed delayed cerebral ischemia, and all were in either the perimesencephalic (1/81; 1%) or diffuse group (2/66; 3%).
Twenty-two patients (10.9%) developed hydrocephalus requiring temporary cerebrospinal fluid diversion, and 5 (2.5%) required a shunt.
Eighty-one patients (40%) underwent a single additional angiogram, and 23 (11%) underwent 2 additional angiograms.
Hydrocephalus and delayed cerebral ischemia do occur in subarachnoid hemorrhage patients with an initial negative angiogram, and the rates increase with more extensive subarachnoid hemorrhage.
Repeat angiography was only useful in patients with diffuse or focal blood distribution patterns. MRI/magnetic resonance angiography of brain did not yield a missed vascular lesion in any patient.