From the Guidelines
A repeat CT head scan is not routinely recommended after an embolization procedure for patients who are neurologically intact and have a normal initial head CT, unless there are new neurological symptoms or concerns for potential complications. The evidence suggests that the risk of delayed intracranial hemorrhage (ICH) in patients on anticoagulants or antiplatelet therapy after a minor head injury is low, and most studies support the notion that delayed ICH after blunt head trauma in neurologically intact patients on anticoagulant or antiplatelet therapy is rare 1.
The American College of Radiology (ACR) Appropriateness Criteria also suggest that repeat CT scans are not necessary in the absence of neurologic deterioration, even in patients with coagulopathy 1. However, it is essential to provide clear discharge instructions with return precautions, as some patients may still develop delayed ICH. The decision to perform additional imaging should be based on the patient's clinical status and specific findings on the initial post-procedure scan. If the patient develops new neurological symptoms at any point after the procedure, an urgent CT scan should be performed to assess for potential complications.
Some studies have reported a low incidence of delayed ICH in patients on anticoagulants or antiplatelet therapy, ranging from 0.6% to 6% 1. However, most of these cases did not require neurosurgical intervention, and the overall risk of clinically significant delayed ICH is low. The ACR Appropriateness Criteria also recommend against routine repeat CT in the presence of a normal initial CT and in the absence of neurologic deterioration 1.
In summary, a repeat CT head scan is not routinely recommended after an embolization procedure for patients who are neurologically intact and have a normal initial head CT, unless there are new neurological symptoms or concerns for potential complications. The decision to perform additional imaging should be based on the patient's clinical status and specific findings on the initial post-procedure scan, and clear discharge instructions with return precautions should be provided to all patients.
From the Research
Patient Need for Repeat CT Head After Embolization Procedure
- The provided studies do not directly address the need for a repeat CT head after an embolization procedure. However, they do discuss the role of repeat CT scans in patients with traumatic brain injury (TBI) and mild head trauma.
- A study published in 2018 2 found that in patients with mild traumatic brain injury, repeat CT scans did not show significant worsening of posttraumatic lesions, and a control scan can be safely delayed up to 48 hours.
- Another study from 2007 3 suggested that routine repeat head CT is indicated for patients with a Glasgow Coma Scale (GCS) score ≤8, as results might lead to intervention without neurologic change.
- A 2019 study 4 found that lower GCS score at admission, abnormal international normalized ratio (INR), presence of midline shift, effaced basal cisterns, and multiple lesions on initial CT were associated with worsening of repeat CT, neurological deterioration, and/or need for neurosurgical intervention.
- A 2018 study 5 questioned the necessity of routine repeat head CT for patients with mild TBI, suggesting that clinically stable patients with small injury can simply be followed clinically.
- A 2023 study 6 found a low frequency and severity of intracranial hemorrhages in mild traumatic brain injury patients under antithrombotic therapy, suggesting the limited benefit of systematic CT head scan as a standard practice for the management of these patients.
Factors Influencing the Need for Repeat CT Head
- GCS score at admission 3, 4
- Abnormal INR 4
- Presence of midline shift 4
- Effaced basal cisterns 4
- Multiple lesions on initial CT 4
- Clinical stability and small injury size 5
Implications for Patient Care
- Clinically stable patients with mild TBI and small injury may not require routine repeat head CT 5
- Patients with lower GCS score, abnormal INR, and other risk factors may benefit from closer monitoring and repeat CT scans 4
- The use of antithrombotic therapy may not significantly increase the risk of intracranial hemorrhages in mild TBI patients 6