title: Benefit of second catheter angiography in patients with nontraumatic subarachnoidal hemorrhage.
abstract: OBJECTIVE
  This study aimed to determine the yield of repetitive catheter angiography (digital subtraction angiography (DSA)) for the detection of causative vascular lesions in patients with nontraumatic subarachnoidal hemorrhage (SAH) and negative initial DSA. We hypothesize that a second DSA might be helpful to detect an initially occult bleeding source.
  
  
  METHODS
  We retrospectively evaluated 649 patients with acute SAH and invasive catheter angiographies between 2004 and 2012. In 90 SAH patients initial imaging was negative concerning a causative bleeding source. A total of 113 repetitive DSA were performed. Two neuroradiologists reanalyzed the initial imaging and the result of the reangiography independently.
  
  
  RESULTS
  In 4/90 patients (4.5 %) bleeding source was first detected in the second or third DSA. In all other patients, no causative vascular lesion was found. Reasons for the initially false negative diagnostics were one dissecting aneurysm and thrombosis of three aneurysms within the acute phase of SAH.
  
  
  CONCLUSIONS
  Repetitive DSA revealed the cause of SAH in 4.5 % of the cases. These findings have a therapeutic and prognostic impact. We think that at least a second DSA should be part of diagnostic work-up in patients with SAH and missing bleeding source, even considering the risk of an additional invasive angiography itself.
authors.affiliation: Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany, adrian.ringelstein@uk-essen.de.
authors.forename: A
authors.initials: A
authors.lastname: Ringelstein
authors.forename: O
authors.initials: O
authors.lastname: Mueller
authors.forename: S L
authors.initials: SL
authors.lastname: Goericke
authors.forename: C
authors.initials: C
authors.lastname: Moenninghoff
authors.forename: U
authors.initials: U
authors.lastname: Sure
authors.forename: I
authors.initials: I
authors.lastname: Wanke
authors.forename: M
authors.initials: M
authors.lastname: Forsting
authors.forename: M
authors.initials: M
authors.lastname: Schlamann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods*; D002406:Catheterization, Peripheral / Q000379:methods*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging*; D055815:Young Adult