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AJNR - American Journal of Neuroradiology

Published ahead of print on September 24, 2009
doi: 10.3174/ajnr.A1803

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American Journal of Neuroradiology 31:230-234, February 2010
© 2010 American Society of Neuroradiology

PATIENT SAFETY

The Safety of Dedicated-Team Catheter-Based Diagnostic Cerebral Angiography in the Era of Advanced Noninvasive Imaging

R. Thiex^a, A.M. Norbash^a and K.U. Frerichs^a

^aFrom the Department of Neurosurgery, Division of Endovascular Neurosurgery and Interventional Neuroradiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Please address correspondence to Kai U. Frerichs, MD,Departments of Radiology and Neurosurgery, Division of Endovascular Neurosurgery and Interventional Neuroradiology, Brigham and Women's Hospital. 75 Francis St, Boston, MA 02115; e-mail: kfrerichs{at}partners.org

BACKGROUND AND PURPOSE: Given the current high quality and usefulness of noninvasive cerebrovascular imaging, invasive angiographic evaluation of the cerebrovascular system is justified if the procedural risk for a neurologic complication is far below the anticipated benefit. The purpose of this study was to evaluate the safety of diagnostic cerebral angiography provided by a dedicated neurointerventional team in a high-volume university hospital.

MATERIALS AND METHODS: A consecutive cohort of 1715 patients undergoing diagnostic cerebral angiography at our institution from 2000 to 2008 was retrospectively assessed for incidence of stroke or TIA related to cerebral angiography. In the subgroup of patients (n = 40) who serendipitously underwent DWI within the first 30 days after cerebral angiography, the presence of new DWI hyperintensities found in territories explored during angiography was tabulated. Complications related to the catheter technique and sheath placement were also studied.

RESULTS: No stroke or permanent neurologic deficit was seen in any of the 1715 patients undergoing diagnostic neuroangiography. One patient experienced a TIA. Nonneurologic complications without long-term sequelae occurred in 9 patients. Two patients had punctate areas of restricted diffusion in territories that had been angiographically explored.

CONCLUSIONS: Within a high-volume neurointerventional practice, the risk for neurologic complications related to catheter-based diagnostic cerebral angiography can approach zero. As the absolute number of invasive diagnostic procedures diminishes with time, diagnostic cerebral angiography remains a useful tool while providing a foundation for neuroendovascular interventions, and should preferably be performed in institutions with high-volume operators also capable of managing unanticipated complicating adverse events.

Abbreviations: CTA, CT angiography • DSA, digital subtraction angiography • DWI, diffusion-weighted MR imaging • ICA, internal carotid artery • MCA, middle cerebral artery • MRA, MR angiography • TIA, transient neurologic deficit/transient ischemic attack