Accuracy of On-Call Resident Interpretation of CT Angiography for Intracranial Aneurysm in Subarachnoid Hemorrhage

OBJECTIVE. The purpose of this article is to evaluate the accuracy of preliminary on-call radiology resident interpretation of CT angiography (CTA) compared with digital subtraction angiography (DSA) in detecting cerebral aneurysms in subarachnoid hemorrhage (SAH).
MATERIALS AND METHODS. A retrospective review compared resident interpretations of head CTA performed after hours for SAH to the results of DSA. The sensitivity and specificity of resident interpretations were classified on a per-patient and per-aneurysm basis. The accuracy of resident interpretations was also determined according to aneurysm location and number.
RESULTS. Between January 2007 and December 2009, 83 patients with SAH underwent both CTA and DSA. DSA documented an aneurysm in 53 of 83 patients. Per patient, residents identified at least one aneurysm in 46 of 53 patients (87%). Per aneurysm, resident sensitivity and specificity for detecting aneurysms of any size were 62% and 91%, respectively, which improved for aneurysms 3 mm or larger to 73% and 97%, respectively. The posterior communicating and intracranial internal carotid arteries were resident "blind spots," with aneurysms 3 mm or larger detected with sensitivities of 33% and 50%, respectively. In contrast, anterior communicating artery aneurysms were correctly identified 95% of the time. In only 35% of cases with multiple aneurysms did residents correctly identify more than one aneurysm.
CONCLUSION. The sensitivity of on-call resident interpretation of CTA for aneurysms in SAH is lower than expected, with a potential for delay in diagnosis and management in a small number of patients. Focused training to carefully review apparent blind spots and the frequency of multiple aneurysms may reduce inaccuracies.

Interventional Stroke Therapies in the Elderly: Are We Helping?

BACKGROUND AND PURPOSE:
It is unclear whether endovascular therapies for the treatment of AIS are being offered or are safe in older adults. The use and safety of endovascular interventions in patients older than 75 years of age were assessed.
MATERIALS AND METHODS:
A retrospective review of patients with AIS 75 years or older (n = 37/1064) was compared with a younger cohort (n = 70/1190) by using an established data base. Admission and discharge NIHSS scores, rates of endovascular treatment, SICH, in-hospital mortality, and the mBI were assessed.
RESULTS:
Rates of endovascular treatments were significantly lower in older patients (5.9% in the younger-than-75-year versus 3.5% in the older-than-75-year cohort, P = .007). Stroke severity as measured by the NIHSS score was equivalent in the 2 age groups. The mBI at 12 months was worse in the older patients (mild or no disability in 52% of the younger-than-75-year and 22% in the 75-year-or-older cohort, P = .006). Older patients had higher rates of SICH (9% in younger-than-75-year versus 24% in the 75-year-or-older group, P = .04) and in-hospital mortality (26% in younger-than-75-year versus 46% in the 75-year-or-older group, P = .05).
CONCLUSIONS:
Patients older than 75 years of age were less likely to receive endovascular treatments. Older patients had higher rates of SICH, disability, and mortality. Prospective randomized trials are needed to determine the criteria for selecting patients most likely to benefit from acute endovascular therapies.