Digital subtraction angiography findings and population demographics of patients with subarachnoidal haemorrhage and subsequent causative aneurysms at Universitas Academic Hospital, Bloemfontein

Abstract

Background: Subarachnoid haemorrhage (SAH) secondary to aneurysmal rupture may be associated with serious neurological sequelae or even mortality. According to international literature, only aneurysms >7 mm or aneurysms in the posterior circulation require treatment. Retrospective single-centre studies have, however, disputed this after demonstrating that the average size of ruptured aneurysms are <7 mm. More recent guidelines place less emphasis on size and more on associated risk factors.Objectives: The aim of this investigation was to assess the aneurysm characteristics and demographics of patients who presented to our institution with SAH secondary to an aneurysm detected at digital subtraction angiography (DSA).Method: A retrospective descriptive study was conducted. Patients who presented with SAH over a 6-year period, from 2008 to 2013, were included. The average size of the intracranial aneurysms at the time of rupture was analysed. Data about aneurysm characteristics and patient demographics were obtained from patient files. Data were analysed by the researchers with assistance from the Department of Biostatistics.Results: In total, 161 of 374 patients who underwent DSA had ruptured aneurysms. Most patients were women with ages ranging from 18 to 73 years (mean 45 years). The mean size of aneurysms were 5.8 mm (range 1.2 mm – 20 mm), with 74.5% of aneurysms <7 mm. Most aneurysms were noted involving the anterior circulation (72%), with the majority arising from the anterior communicating artery (36.7%).Conclusion: We found that aneurysms rupture at sizes <7 mm and are commonly located in the anterior circulation. Our findings emphasise the importance of conducting institutional reviews to consider adapting international treatment guidelines for the local South African situation.