2014 Volume 26 Issue 2 Pages 20-26
Three-dimensional CT angiography (3D-CTA) is now widely used as the first-line diagnostic modality to identify ruptured aneurysms in patients with subarachnoid hemorrhage (SAH). However, there is a risk of aneurysm rerupture in the hyperacute phase. We sought to clarify the incidence of rerupture and characterize the patients showing extravasation of contrast media during 3D-CTA and digital subtraction angiography (DSA). We examined the records of 391 consecutive patients with non-traumatic SAH between October 2003 and September 2012. After resuscitation, patients with poor grade SAH underwent CT then 3D-CTA while sedated, mechanically ventilated and with a target systolic blood pressure of 120 mmHg. Three hundred sixty six patients underwent 3D-CTA and 112 of them underwent subsequent DSA; 20 died without return of spontaneous circulation. Extravasated contrast medium was seen in 16 (4.4%) at the initial evaluation during CTA and in 7 (6.3%) during DSA. Those patients were in poor-grade and arrived very early phase after SAH onset, presenting extremely high blood pressure, and frequent episodes suggestive of aneurysm rerupture. Continuous or intermittent rebleeding may occur frequently in hyperacute SAH patients. The consequences of rebleeding are devastating; however, favorable results can be obtained with immediate aneurysm repair with decompression and intensive neurocritical care.
