title: Diagnostic yield of catheter angiography in patients with subarachnoid hemorrhage and negative initial noninvasive neurovascular examinations.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Division of Interventional Neuroradiology, Abbott Northwestern Hospital, Minneapolis, Minnesota 55407, USA. josser.delgado@crlmed.com
authors.forename: J E
authors.initials: JE
authors.lastname: Delgado Almandoz
authors.forename: B M
authors.initials: BM
authors.lastname: Crandall
authors.forename: J L
authors.initials: JL
authors.lastname: Fease
authors.forename: J M
authors.initials: JM
authors.lastname: Scholz
authors.forename: R E
authors.initials: RE
authors.lastname: Anderson
authors.forename: Y
authors.initials: Y
authors.lastname: Kadkhodayan
authors.forename: D E
authors.initials: DE
authors.lastname: Tubman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods* / Q000592:standards; D002533:Cerebral Angiography / Q000379:methods* / Q000592:standards; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology*; D014057:Tomography, X-Ray Computed / Q000592:standards