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Utility of Surveillance Angiography in Aneurysmal Subarachnoid Hemorrhage: A Retrospective Study of 223 Consecutive Patients

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Abstract

Background

Patients with aneurysmal subarachnoid hemorrhage (aSAH) who survive the rupture are at risk for delayed neurologic deficits and cerebral infarction. The ideal method(s) of surveillance for cerebral vasospasm, and the link between radiographic vasospasm and delayed neurologic deficits, remain controversial. We instituted a postbleed day 7 angiography protocol with the stated goals of identification of vasospasm, improving neurologic outcomes, and possibly lowering cost of care.

Methods

We conducted a quality improvement project in which we retrospectively analyzed consecutive cases of aSAH from a single institution over a 5-year period. Patients were excluded if they did not receive treatment for their aneurysm or were < 18 years of age. We analyzed demographic and outcome information for patients managed by protocolled angiography versus those who were managed by as-needed endovascular rescue therapy. Statistical tests were performed comparing means and proportions in both cohorts, as appropriate.

Results

In total, 223 patients were identified who met inclusion criteria. In total, 157 patients were identified in the protocolled day 7 angiography group, and 66 were in the nonprotocolled angiography group. Demographics were similar between the day 7 angiogram and medical management cohorts, except for a higher mean age among the latter group (p = 0.016). The protocolled angiography group underwent a significantly greater number of angiograms (p < 0.001) and had a significantly higher cost of hospitalization ($240,327 vs. $205,719, p = 0.03), with no significant difference in rate of cerebral infarction, length of intensive care unit stay, length of hospital stay, discharge location, or discharge modified Rankin Score.

Conclusions

This cohort comparison analysis draws into question the practice of protocolized cerebral angiography in patients with aSAH.

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Funding

No funding was supplied for this study.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA

    Matthew J. Kole, Juan Carlos Martinez-Gutierrez, Hussein A. Zeineddine & Peng Roc Chen

  2. Department of Neurosurgery and Neuroscience Institute, Geisinger Medical Center, Danville, PA, USA

    Matthew J. Kole

  3. Geisinger Commonwealth School of Medicine, Scranton, PA, USA

    Matthew J. Kole

  4. Department of Pediatrics, Center for Clinical Research and Evidence-Based Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA

    Van Thi Thanh Truong

Authors
  1. Matthew J. Kole
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  2. Juan Carlos Martinez-Gutierrez
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  3. Hussein A. Zeineddine
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  4. Van Thi Thanh Truong
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  5. Peng Roc Chen
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Contributions

Conceptualization (MJK, PRC, MCMG, HAZ), data gathering (MJK, MCMG, HAZ), statistical analysis (MJK, VTTT), drafting and editing of manuscript (MJK, PRC, MCMG, HAZ, VTTT). This manuscript was approved by all authors.

Corresponding author

Correspondence to Matthew J. Kole.

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Conflicts of interest

PRC has grant funding from Stryker Neurovascular; however, they had neither a role in funding the present work nor input regarding its design, analysis, or decision to publish.

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This article adheres to ethical guidelines and is institutional review board approved (HSC-MS-22–0403). Informed consent was not required because of the retrospective nature.

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Kole, M.J., Martinez-Gutierrez, J.C., Zeineddine, H.A. et al. Utility of Surveillance Angiography in Aneurysmal Subarachnoid Hemorrhage: A Retrospective Study of 223 Consecutive Patients. Neurocrit Care (2023). https://doi.org/10.1007/s12028-023-01892-1

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  • DOI: https://doi.org/10.1007/s12028-023-01892-1

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