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PT  - JOURNAL ARTICLE
AU  - Delgado Almandoz, J.E.
AU  - Crandall, B.M.
AU  - Fease, J.L.
AU  - Scholz, J.M.
AU  - Anderson, R.E.
AU  - Kadkhodayan, Y.
AU  - Tubman, D.E.
TI  - Diagnostic Yield of Catheter Angiography in Patients with Subarachnoid Hemorrhage and Negative Initial Noninvasive Neurovascular Examinations
AID  - 10.3174/ajnr.A3291
DP  - 2013 Apr 01
TA  - American Journal of Neuroradiology
PG  - 833--839
VI  - 34
IP  - 4
4099  - http://www.ajnr.org/content/34/4/833.short
4100  - http://www.ajnr.org/content/34/4/833.full
SO  - Am. J. Neuroradiol.2013 Apr 01; 34
AB  - BACKGROUND AND PURPOSE: The yield of DSA in patients with SAH and negative initial noninvasive neurovascular examinations (CTA or MRA) is not well-understood. This study aimed to determine the yield of DSA for the detection of causative vascular lesions in this clinical scenario. MATERIALS AND METHODS: We examined the yield of DSA for the detection of causative vascular lesions in a cohort of patients presenting to our institution with SAH and negative initial noninvasive neurovascular examinations during a 5-year period. Two experienced neuroradiologists independently evaluated the NCCT to determine the SAH pattern (diffuse, perimesencephalic, or peripheral sulcal) and the catheter angiograms to assess the presence of a causative vascular lesion. RESULTS: Fifty-five patients were included in the study, with a mean age of 58.2 years (median, 58 years; range, 25–88 years). Twenty-eight patients were men (50.9%), and 27 were women (49.1%). The initial noninvasive examination was a CTA in 47 patients (85.5%) and an MRA in 8 patients (14.5%). Thirty-three patients had diffuse SAH (60%); 11, perimesencephalic SAH (20%); and 11, peripheral sulcal SAH (20%). DSA demonstrated a causative vascular lesion in 6 patients (10.9%), 5 of whom had diffuse SAH (yield of 15.2%) and 1 of whom had peripheral sulcal SAH (yield of 9.1%). No causative vascular lesions were found in patients with perimesencephalic SAH. CONCLUSIONS: DSA is a valuable tool in the evaluation of patients with diffuse and peripheral sulcal SAH who have negative initial noninvasive neurovascular examinations, demonstrating a causative vascular lesion in 15.2% and 9.1% of patients, respectively. CIconfidence intervalDAVFdural arteriovenous fistula