Use of CT angiography and digital subtraction angiography in patients with ruptured cerebral aneurysm: Evaluation of a large multihospital data base

BACKGROUND AND PURPOSE: Both CT angiography and digital subtraction angiography are used to detect aneurysms in patients with subarachnoid hemorrhage. We examined a large multihospital data base to determine how practice is evolving with regard to the use of CT angiography and DSA in patients with ruptured cerebral aneurysm. MATERIALS AND METHODS: The Premier Perspective data base was used to identify hospitalizations of patients treated with clipping or coiling of ruptured cerebral aneurysms from 2006-2011. Billing information was used to determine pretreatment and posttreatment use of DSA and CT angiography during hospitalization. RESULTS: A total of 4972 patients (1022 clipping, 3950 coiling) at 116 hospitals were identified. The percentage of patients with SAH who underwent pretreatment CT angiography significantly increased from 20% in 2006 to 44% in 2011 (P <.0001), whereas the percentage of patients who underwent DSA remained unchanged from 96-94% (P =.28). This CT angiography trend was observed in coiling patients (17-42%, P <.0001) and clipping patients (32-54%, P <.0001). There was a significant increase in the percentage of patients who underwent posttreatment imaging from 41% in 2006 to 48% in 2011 (P =.0037). This trend was observed in clipping patients (33-65%, P<.0001) but not coiling patients (43-45%, P =.62). CONCLUSIONS: For the pretreatment evaluation of ruptured aneurysms, the use of CT angiography increased from 2006-2011 without a corresponding decrease in the use of DSA. These results raise the question of potential redundancy without added clinical value of the second test.