{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T23:09:07Z","timestamp":1790636947829,"version":"4.1.0"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100017590","name":"Universit\u00e4tsklinikum Essen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100017590","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neuroradiology"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To assess the diagnostic yield and clinical relevance of repeated digital subtraction angiography (DSA) in patients with spontaneous perimesencephalic non-aneurysmal subarachnoid hemorrhage (PMSAH) and to evaluate DSA-related complication rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective analysis of 82 patients with PMSAH confirmed by non-contrast CT between March 2002 and February 2025. All patients underwent initial computed tomography angiography (CTA) and first DSA on average within 24\u00a0h. If no bleeding source was identified, a second DSA was performed after 10\u201314 days. Clinical data, radiological findings, and complications were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The initial DSA showed no vascular abnormality in 76\/82 patients (92.7%). A second DSA was performed in 60\/76 cases (78.9%) and identified two small basilar artery aneurysms (3.3%) that were not visible on the initial CTA or DSA but were detectable on repeat 3D rotational angiography (3DRA). Procedure-related complications occurred in three DSAs (2%), including a cerebellar infarct, supratentorial embolism, and local puncture site complication. Most patients had a benign clinical course, and only one in-hospital death was documented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The diagnostic benefit of repeat DSA in typical PMSAH is low, with no clear therapeutic impact and a relevant risk of complications. Given the benign course of PMSAH and the availability of high-resolution non-invasive imaging such as dual-source, photon-counting CTA, or vessel wall MRI, repeat DSA should be reserved for selected cases with atypical features or clinical deterioration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00234-025-03779-8","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T10:56:01Z","timestamp":1758884161000},"page":"3185-3194","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Perimesencephalic non-aneurysmal subarachnoid hemorrhage: is there a need for repeat digital subtraction angiography?"],"prefix":"10.1007","volume":"67","author":[{"given":"Rosa","family":"Schubert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maharani Budi","family":"Santoso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelius","family":"Deuschl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramazan","family":"Jabbarli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Sure","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Forsting","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Styczen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"issue":"4","key":"3779_CR1","doi-asserted-by":"publisher","first-page":"1326","DOI":"10.1161\/STROKEAHA.119.025997","volume":"51","author":"M Maher","year":"2020","unstructured":"Maher M, Schweizer TA, Macdonald RL (2020) Treatment of spontaneous subarachnoid hemorrhage: guidelines and gaps. 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The study was conducted in accordance with the 1964 Declaration of Helsinki and its subsequent amendments or comparable ethical standards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable. All presented images (CT, DSA) are fully anonymized, and no identifying information of patients is included in this manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"Due to the retrospective and anonymized nature of this study, additional informed consent was not required and was waived by the local Ethics Committee.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}