Very poor prognosis in cases with extravasation of the contrast medium during angiography. 1996

T Yasui, and H Kishi, and M Komiyama, and Y Iwai, and K Yamanaka, and M Nishikawa
Department of Neurosurgery, Osaka City General Hospital, Japan.

BACKGROUND The rebleeding of a ruptured intracranial aneurysm in the acute stage has been thought to indicate a very poor prognosis. In our experience, the outcome of patients with extravasation of the contrast medium is worse than that of patients with rerupture under circumstances other than angiography. We demonstrated the poorer outcome of the patients with extravasation, compared to that of the patients developing rerupture under circumstances other than angiography, and examined the factors that contributed to the poorer outcome of the patients with extravasation. METHODS Among the 641 cases of ruptured intracranial aneurysm, we have handled over the past 10 years, 36 (5.6%) patients have rebled before surgery was performed. Thirteen patients rebled during angiography (Group I), and the remaining 23 patients rebled in other circumstances (Group II). We compared the outcome of both groups. RESULTS The rebleeding occurred within 6 hours of the initial rupture in 29 (80%) patients. The outcome of Group I was significantly poorer than that of Group II (p < 0.05). In Group I, SD was achieved in only 1 patient and the remaining 12 patients died, while in Group II, 8 patients were in GR or MD, 2 were in SD, and the remaining 13 patients died. CONCLUSIONS Because rebleeding during angiography most often occurs in the acute stage and because the outcome of patients with extravasation is very poor, we recommend that the performance of angiography be delayed at least between 3 and 6 hours after the initial rupture.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D002533 Cerebral Angiography Radiography of the vascular system of the brain after injection of a contrast medium. Angiography, Cerebral,Angiographies, Cerebral,Cerebral Angiographies
D002536 Cerebral Arteries The arterial blood vessels supplying the CEREBRUM. Arteries, Cerebral,Artery, Cerebral,Cerebral Artery
D005119 Extravasation of Diagnostic and Therapeutic Materials The escape of diagnostic or therapeutic material from the vessel into which it is introduced into the surrounding tissue or body cavity. Extravasation of Contrast Media,Extravasation of Diagnostic, Therapeutic Materials,Contrast Media Extravasation
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults

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