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Original research
Preoperative cerebral angiography nearly doubles the rate of diffusion-weighted imaging lesion detection following minimally invasive surgery for intracerebral hemorrhage
  1. Christina P Rossitto,
  2. Vikram Vasan,
  3. Margaret H Downes,
  4. Sema Yildiz,
  5. Colton J Smith,
  6. John W Liang,
  7. Alexander J Schupper,
  8. Trevor Hardigan,
  9. Xinyan Liu,
  10. Muhammad Ali,
  11. Emily K Chapman,
  12. Alex Devarajan,
  13. Ian C Odland,
  14. Christopher P Kellner,
  15. J Mocco
  1. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  1. Correspondence to Christina P Rossitto, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA; christina.rossitto{at}


Background Diffusion-weighted imaging (DWI) lesions have been linked to poor outcomes after intracerebral hemorrhage (ICH). We aimed to assess the impact of cerebral digital subtraction angiography (DSA) on the presence of DWI lesions in patients who underwent minimally invasive surgery (MIS) for ICH.

Methods Retrospective chart review was performed on ICH patients treated with MIS in a single health system from 2015 to 2021. One hundred and seventy consecutive patients who underwent postoperative MRIs were reviewed. Univariate analyses were conducted to determine associations. Variables with p<0.05 were included in multivariate analyses.

Results DWI lesions were present in 88 (52%) patients who underwent MIS for ICH. Of the 83 patients who underwent preoperative DSA, 56 (67%) patients demonstrated DWI lesions. In this DSA cohort, older age, severe leukoaraiosis, larger preoperative hematoma volume, and increased presenting National Institutes of Health Stroke Score (NIHSS) were independently associated with DWI lesion identification (p<0.05). In contrast, of 87 patients who did not undergo DSA, 32 (37%) patients demonstrated DWI lesions on MRI. In the non-DSA cohort, presenting systolic blood pressure, intraventricular hemorrhage, and NIHSS were independently associated with DWI lesions (p<0.05). Higher DWI lesion burden was independently associated with poor modified Rankin Scale (mRS) at 6 months on a univariate (p=0.02) and multivariate level (p=0.02).

Conclusions In this cohort of ICH patients who underwent minimally invasive evacuation, preprocedural angiography was associated with the presence of DWI lesions on post-ICH evacuation MRI. Furthermore, the burden of DWI lesions portends a worse prognosis after ICH.

  • Lesion
  • Hemorrhage
  • Intervention
  • Angiography
  • Stroke

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Twitter @cprossitto, @ASchupperMD, @MuhammadM_Ali, @AlexDevarajan, @chriskellnerMD, @JMoccoMD

  • Contributors CPR: guarantor, methodology, data curation, formal analysis, writing - original draft preparation. VV: data curation. MHD: data curation. SY: data curation. CJS: writing - reviewing and editing. JL: writing - reviewing and editing. AJS: data curation, writing - reviewing and editing. TH: data curation, writing - reviewing and editing. XL: formal analysis. MA: writing - reviewing and editing. EKC: data curation, writing - reviewing and editing. AD: writing - reviewing and editing. ICO: writing - reviewing and editing. CPK: conceptualization, methodology, supervision. JM: conceptualization, methodology, supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JM is the president of the SNIS board of directors. JM reported serving as a principal investigator on funded research trials for Stryker Neurovascular, Microvention, and Penumbra; being an investor in Cerebrotech, Imperative Care, Endostream, Viseon, BlinkTBI, Myra Medical, Serenity, Vastrax, NTI, RIST,, Synchron, Radical, Truvic, Tulavi, and Neurolutions; and serving as a consultant for Cerebrotech, Viseon, Endostream, Vastrax, RIST, Synchron,, Perflow, and CVAid outside the submitted work. CPK has received research grant support from Cerebrotech, Siemens, Penumbra, Medtronic, Minnetronix, Viz.AI, Integra, Longeviti, Irras, ICE Neurosystems, CVAID, and Endostream; and has ownership interest in Precision Recovery, Borealis, and Metis Innovative. Metis Innovative is an investment group that has coordinated investments in Synchron, Proprio, Fluid Biotech, Precision Recovery, and Von Medical. The other authors have no stated conflicts of interest nor financial disclosures.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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