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ArticleNeuroradiology2025

Perimesencephalic non-aneurysmal subarachnoid hemorrhage: is there a need for repeat digital subtraction angiography?

Rosa Schubert, Maharani Budi Santoso, Yan Li, Cornelius Deuschl, Ramazan Jabbarli, Ulrich Sure, Michael Forsting, Hanna Styczen

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neuroradiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

8 authors.

Rosa SchubertInstitute for Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Essen, Germany. rosa.schubert@stud.uni-due.de.
Maharani Budi SantosoInstitute for Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Essen, Germany.
Yan LiInstitute for Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Essen, Germany.
Cornelius DeuschlInstitute for Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Essen, Germany.
Ramazan JabbarliDepartment of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany.
Ulrich SureDepartment of Neurosurgery and Spine Surgery, University of Duisburg-Essen, Essen, Germany.
Michael ForstingInstitute for Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Essen, Germany.
Hanna StyczenInstitute for Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Essen, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo assess the diagnostic yield and clinical relevance of repeated digital subtraction angiography (DSA) in patients with spontaneous perimesencephalic non-aneurysmal subarachnoid hemorrhage (PMSAH) and to evaluate DSA-related complication rates.

methodsRetrospective analysis of 82 patients with PMSAH confirmed by non-contrast CT between March 2002 and February 2025. All patients underwent initial computed tomography angiography (CTA) and first DSA on average within 24 h. If no bleeding source was identified, a second DSA was performed after 10-14 days. Clinical data, radiological findings, and complications were evaluated.

resultsThe initial DSA showed no vascular abnormality in 76/82 patients (92.7%). A second DSA was performed in 60/76 cases (78.9%) and identified two small basilar artery aneurysms (3.3%) that were not visible on the initial CTA or DSA but were detectable on repeat 3D rotational angiography (3DRA). Procedure-related complications occurred in three DSAs (2%), including a cerebellar infarct, supratentorial embolism, and local puncture site complication. Most patients had a benign clinical course, and only one in-hospital death was documented.

conclusionThe diagnostic benefit of repeat DSA in typical PMSAH is low, with no clear therapeutic impact and a relevant risk of complications. Given the benign course of PMSAH and the availability of high-resolution non-invasive imaging such as dual-source, photon-counting CTA, or vessel wall MRI, repeat DSA should be reserved for selected cases with atypical features or clinical deterioration.

Indexed as

Angiography, Digital SubtractionCerebral AngiographySubarachnoid HemorrhageAdultAgedAged, 80 and overComputed Tomography AngiographyFemaleHumansMaleMiddle AgedRetrospective StudiesDigital subtraction angiographyNon-aneurysmal subarachnoid hemorrhagePerimesencephalic subarachnoid hemorrhageRepeat angiograph

Identifiers

PMID41003694
PMCPMC12743060

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.