Evolution from invasive arterial puncture to a venous access for cerebral angiography: "Cath Lab to CT suite"

Background: Digital subtraction angiography (DSA) is considered as the gold standard in the evaluation of intracranial aneurysms. This study was undertaken to evaluate the effectiveness of computed tomogram angiography (CTA) in the detection and accurate characterization of intracranial aneurysms in suspected cases of nontraumatic subarachnoid hemorrhage. The importance of three-dimensional volume rendering of the intracranial vasculature and it′s used as an aid in improving diagnostic capabilities with regards to intracranial aneurysms in multi-detector computed tomography angiography (MDCTA), was stressed upon. This study also tried to probe whether MDCTA alone can be used in detection and treatment of intracranial aneurysms in emergency situations. Materials and Methods: Suspected cases of nontraumatic acute subarachnoid hemorrhage, over an 18 months period, underwent CTA in 16-slice-computed tomography suite. Fifty cases where CTA demonstrated intracranial aneurysms were studied. A set protocol of three-dimensional reconstruction was followed. Comparison of findings of MDCTA with surgical notes was performed. DSA was done in ambiguous cases. Results: Aneurysm was confidently diagnosed by CTA in 48 cases, and further confirmed on surgery. In doubtful cases, DSA was performed and then diagnosed as aneurysm. Thus, the sensitivity of CTA is diagnosing aneurysm is 96.6%, with a specificity of 100%. Conclusions: Digital subtraction angiography is an invasive, relatively costly, procedure to be done by highly skilled personnel with serious complication rate of 1%. This can be replaced by MDCTA, which is noninvasive, cost effective and easy to perform, and DSA can be reserved for doubtful or difficult cases. Following a set protocol of three-dimensional reconstruction helps in reducing errors