Abstract
Although three-dimensional computed tomographic angiography (3D-CTA) is less complicated and time-consuming than conventional cerebral angiography (CCA) and represents a reliable alternative for evaluating cerebral aneurysms, some patients experience aneurysmal rerupture during 3D-CTA. Two women, 79 and 71 years old, who presented with severe subarachnoid hemorrhage (SAH) underwent 3D-CTA within 3 h after SAH onset. Their images clearly indicated extravasation from their aneurysms. Neither patient recovered from deep coma, and both died within 2 days. We reviewed the literature with special reference to the condition of SAH patients at admission and the interval between SAH onset and 3D-CTA, and discuss serious complications of 3D-CTA study. Although aneurysmal rerupture may reflect the natural course, rerupture during 3D-CTA, especially in SAH patients who are in poor clinical condition during the acute stage, should be recognized as a potentially fatal complication. Their blood pressure must be strictly controlled and factors such as their clinical condition and the interval from the ictus must be considered.
Similar content being viewed by others
References
Chappell ET, Moure FC, Good MC (2003) Comparison of computed tomographic angiography with digital subtraction angiography in the diagnosis of cerebral aneurysms: A meta-analysis. Neurosurgery 52:624–631
Hamada J, Morioka M, Yano S, Kai Y, Ushio Y (2004) Incidence and early prognosis of aneurysmal subarachnoid hemorrhage in Kumamoto Prefecture, Japan. Neurosurgery 54:31–38
Holodny A, Farkas J, Schlenk R, Maniker A (2003) Demonstration of an actively bleeding aneurysm by CT angiography. AJNR Am J Neuroradiol 24:962–964
Josephson SA, Dillon WP, Dowd CF, Malek R, Lawton MT, Smith WS (2004) Continuous bleeding from a basilar terminus aneurysms imaged with CT angiography and conventional angiography. Neurocrit Care 1:103–106
Karamessini MT, Kagadis GC, Petsas T, Karnabatidis D, Konstantinou D, Sakellaropoulous GC, Nikiforidis GC, Siablis D (2004) CT angiography with three-dimensional techniques for the early diagnosis of intracranial aneurysms: Comparison with intra-arterial DSA and surgical findings. Eur J Radiol 49:212–223
Komiyama M, Tamura K, Nagata Y, Fu Y, Yagura H, Yasui T (1993) Aneurysmal rupture during angiography. Neurosurgery 33:798–803
Kusumi M, Yamada M, Kitahara T, Endo M, Kan S, Iida H, Sagiuchi T, Fujii K (2005) Rerupture of cerebral aneurysms during angiography: A retrospective study of 13 patients with subarachnoid hemorrhage. Acta Neurochir (Wien) 147:831–837
Lasser EC, Lamkin GE (2002) Mechanisms of blood pressure change after bolus injections of X-ray contrast media. Acad Radiol 9(Suppl 1):s72–s75
Morcos SK, Dawson P, Pearson JD, Jeremy JY, Davenport AP, Yates MS, Tirone P, Cipolla P, de Haen C, Muschick P, Krause W, Refsum H, Emery CJ, Liss P, Nygren A, Haylor J, Pugh ND, Karlsson JO (1998) The haemodynamic effects of iodinated water-soluble radiographic contrast media: A review. Eur J Radiol 29:31–46
Morcos SK (2003) Review article: Effects of radiographic contrast media on the lung. Br J Radiol 76:290–295
Nakada M, Akaike S, Futami K (2000) Rerupture of an aneurysm during three-dimensional computerized tomography angiography. Case illustration. J Neurosurg 93:900
Nakatsuka M, Mizuno S, Uchida A (2002) Extravasation on three-dimensional CT angiography in patients with acute subarachnoid hemorrhage and ruptured aneurysm. Neuroradiology 44:25–30
Ryu CW, Kim SJ, Lee DH, Suh DC, Kwun BD (2005) Extravasation of intracranial aneurysm during computed tomography-angiography: Mimicking a blood vessel. J Comput Assist Tomogr 29:677–679
Saitoh H, Hayakawa K, Nishimura K, Okuno Y, Teraura T, Yumitori K, Okumura A (1995) Rerupture of cerebral aneurysms during angiography. AJNR Am J Neuroradiol 16:539–542
Saitoh H, Hayakawa K, Nishimura K, Okuno Y, Murayama C, Miyazawa T, Zieroth BF, Shimizu Y (1996) Intracarotid blood pressure changes during contrast medium injection. AJNR Am J Neuroradiol 17:51–54
Tipper G, U-King-Im JM, Price SJ, Trivedi RA, Cross JJ, Higgins NJ, Farmer R, Wat J, Kirollos R, Kirkpatrick PJ, Antoun NM, Gillard JH (2005) Detection and evaluation of intracranial aneurysm with 16-row multislice CT angiography. Clin Radiol 60:565–572
Yasui T, Kishi H, Komiyama M, Iwai Y, Yamanaka K, Nishikawa M (1996) Very poor prognosis in cases with extravasation of the contrast medium during angiography. Surg Neurol 45:560–565
Zaehringer M, Wedekind C, Gossmann A, Krueger K, Trenschel G, Landwehr P (2002) Aneurysmal rerupture during selective angiography. Eur Radiol 12(Suppl 3):s18–s24
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hashiguchi, A., Mimata, C., Ichimura, H. et al. Rebleeding of ruptured cerebral aneurysms during three-dimensional computed tomographic angiography: report of two cases and literature review. Neurosurg Rev 30, 151–154 (2007). https://doi.org/10.1007/s10143-007-0068-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10143-007-0068-6