Current hospital demographics of subarachnoid hemorrhage based on CT angiography and 3D rotational angiography in a neurosurgical center

Abstract

BACKGROUND AND PURPOSE: Aneurysmal subarachnoid hemorrhage is an important cause of mortality and morbidity. Modern hospital demographics are scarce. We evaluated the diagnosis and treatment of patients with SAH in a neurosurgical referral center. MATERIALS AND METHODS: Between March 2013 and April 2015, two hundred eighty-four patients with SAH diagnosed on CT or lumbar puncture were admitted. All patients underwent 64 – to 128 – detector row CT angiography. Additional imaging was with 3D rotational angiography of all vessels. In patients with aneurysms, characteristics and mode of treatment were recorded. RESULTS: In 197 of 220 patients with an aneurysmal bleeding pattern, we found a cause of the bleeding: One hundred ninety-five patients had a ruptured aneurysm (98%); 1 patient, a micro-AVM; and 1 patient, reversible vasoconstriction syndrome. Of 195 ruptured aneurysms, 6 were dissecting aneurysms and 3 were AVM-associated flow aneurysms. In 23 of 204 patients (11%) with an aneurysmal bleeding pattern and 3D rotational angiography performed, no cause was found. In 8 of 9 patients (89%) with lumbar puncture positive for SAH but CT negative for it, no cause was found. Of 180 patients with a ruptured aneurysm eligible for treatment, 147 (82%) were treated endovascularly and 30 aneurysms (17%) were clipped. Of 204 patients with an aneurysmal bleeding pattern and 3D rotational angiography, 72 (35%) had multiple aneurysms. These 72 patients had, altogether, 117 additional aneurysms, of which 24 (21%) were treated by either coiling or clipping. CONCLUSIONS: This study provides robust data on hospital demographics of SAH in a neurosurgical referral center, based on CTA and 3D rotational angiography of all vessels.