Rebleeding from Cerebral Aneurysms during 3DCT Angiography

Background and purpose: Computed Tomographic Angiography (CTA) is commonly used for the non-invasive detection of cerebrovascular lesions responsible for subarachnoid hemorrhage, but rebleeding may occur during this procedure. We investigated imaging findings and related factors in patients who experienced rebleeding during CTA in our hospital. Materials and methods: Participants comprised 112 patients who underwent CTA for ruptured cerebral aneurysm in our hospital between January 10 and December 2015. CTA was performed using a 64-row detector system. Results: Rebleeding occurred during CTA in 5 of 112 patients, representing a rebleeding rate of 4.5%. Mean time from initial onset of hemorrhage to CTA was shorter in patients with rebleeding (median, 88 min) than in patients without rebleeding (median, 228 min; P=0.051), and blood pressure at the time of initial treatment tended to be higher for patients with rebleeding. Patients with rebleeding showed either: a) spiral or wave-shaped hemorrhage into the cistern in which the aneurysm was located; or b) tear-drop-shaped hemorrhage within the hematoma. Patients with rebleeding were all grades 5 according to the World Federation of Neurological Surgeons (WFNS) and underwent CTA within 3 h of onset. Conclusion: CTA offers excellent performance for the diagnosis of cerebral aneurysm, but the use of intravenous contrast agent may carry some risk of rebleeding. History of recent severe subarachnoid hemorrhage also appears to represent a risk factor for rebleeding. As contrast agent injection may produce hemodynamic effects, management of fluctuations in blood pressure during CTA is crucial.