Utility of Urgent Computed Tomography Angiography in the Setting of Intraparenchymal Brain Hemorrhage

Background and Purpose: Patients presenting with an intracerebral hemorrhage (ICH) generally have an initial noncontrast computed tomography (NCCT) of the brain. Computed tomography angiography (CTA) can help identify secondary causes of ICH and detect a "spot sign." We hypothesized that performing an urgent CTA in the setting of a presumed primary ICH has only limited utility and did not alter urgent management. Methods: This was a retrospective study of consecutive patients presenting with a primary ICH identified from the Duke University Stroke Registry from 2010 to 2013 who had an ICH detected on an initial NCCT. Patients with hemorrhages related to tumor, hemorrhagic conversion of an ischemic stroke, and known secondary causes were excluded. CTA within the first 10 hours of presentation was considered "urgent." Results: Of 246 patients meeting the inclusion criteria, 53% had an urgent CTA. Those who underwent a CTA were younger (61 +/- 1 versus 70 +/- 1 years, P < .0001) and more commonly had deep bleeds (50% versus 45%, P = .048). CTA identified 12 aneurysms (10 incidental) and 2 arteriovenous malformations; 87% were normal. Urgent CTA was associated with a change in management in 3 cases (2.2%); each had historic or other findings suggestive of a secondary cause of hemorrhage and none led to urgent treatment changes. Conclusions: In the absence of features suggesting a secondary cause, the results of an urgent CTA did not alter the urgent management of a consecutive series of patients with ICH. CTAs may be safely delayed until after the acute period in these patients.