Key result
Emergency brain CTA identifies secondary vascular pathologies in ~6% of older patients with spontaneous ICH.
Why the study?
The diagnostic utility and clinical justification of emergency brain CTA for identifying secondary vascular etiologies in older patients with spontaneous intracerebral hemorrhage needed evaluation alongside potential systemic and renal risks.
Does emergency brain computed tomography angiography within 24 hours of admission provide clinically useful diagnostic yield and affect functional outcomes or systemic complications in older patients (>=65 years) with spontaneous intracerebral hemorrhage?
Observational (n=150)
No
Does emergency brain computed tomography angiography within 24 hours of admission provide clinically useful diagnostic yield and affect functional outcomes or systemic complications in older patients (>=65 years) with spontaneous intracerebral hemorrhage?
Emergency brain CTA in older patients with spontaneous ICH identifies causative vascular lesions in 6.0% and overall vascular abnormalities in 30.7% to guide rapid management, though 12.0% develop acute kidney injury associated with worse neurological outcomes.
Answers are grounded in this paper and cite their sources.
Low diagnostic yield and AKI risk caution against routine emergency CTA in older spontaneous ICH; supports prospective trials of selective protocols.
Objective: In older patients with spontaneous intracerebral hemorrhage (ICH), brain computed tomography angiography (CTA) is used to identify secondary vascular etiologies. This study evaluated the diagnostic utility of CTA and the clinical justification for its use despite potential systemic risks.Methods: We retrospectively analyzed 150 consecutive patients aged ≥65 years with spontaneous ICH who underwent brain CTA within 24 hours of admission. Diagnostic yield, functional outcomes, including the modified Rankin scale (mRS), and systemic complications were evaluated.Results: Brain CTA identified ICH-related secondary cerebral pathologies in 9 patients (9/150, 6.0%), including ruptured cerebral aneurysms (3.3%, n=5), ruptured arteriovenous malformation or cavernous malformation (1.3%, n=2), moyamoya disease (0.7%, n=1), and tumor-related hemorrhage (0.7%, n=1). These findings guided subsequent management, including endovascular coiling (n=2), craniectomy or craniotomy with ICH aspiration (n=5), and conservative management (n=2). The mRS score did not change significantly from admission to discharge (3.90±1.27 vs. 3.80±1.75, P=0.30). Pneumonia (10.7%), urinary tract infection (8.7%), and acute kidney injury (AKI; 12.0%, n=18) were identified as distinct systemic concerns; among the patients with AKI, 3 required continuous renal replacement therapy. AKI was significantly associated with higher initial systolic blood pressure (P=0.02) and worse functional outcomes (mRS; 5.44±0.7 vs. 3.58±1.7, P<0.001).Conclusion: Brain CTA provided clinically useful diagnostic yield and facilitated decision-making in older patients with spontaneous ICH. Because brain CTA can provide diagnostic information rapidly in the emergency setting, it may be useful in selected older patients with ICH when accompanied by renal protective strategies.
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Ha et al. (2026) conducted an observational in Spontaneous intracerebral hemorrhage (n=150). Emergency brain computed tomography angiography (CTA) was evaluated on Diagnostic yield of ICH-related secondary cerebral vascular pathologies on brain CTA. Emergency brain CTA identified ICH-related secondary vascular pathologies in 6.0% (9/150) of older patients with spontaneous ICH, while 12.0% (18/150) developed acute kidney injury.
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