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Silent microemboli related to diagnostic cerebral angiography: a matter of operator’s experience and patient’s disease

  • Diagnostic Neuroradiology
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Abstract

Introduction

The aim of the present investigation was to elucidate in a large consecutive patient cohort whether the level of training has an effect on the number of microemboli detected by diffusion-weighted imaging (DWI) and which additional risk factors can be identified.

Methods

A total of 107 consecutive patients in whom a diagnostic cerebral angiography had been performed were prospectively investigated with DWI; 51 angiographies were performed by experienced neuroradiologists, 56 by neuroradiologists in training.

Results

In 12 patients (11.1%), a total of 17 new lesions without any clinically overt neurological symptoms were identified. Of these, 12 patients, 11 (91.7%) with 16 lesions were investigated by junior neuroradiologists. In 11 of 12 patients with DWI abnormalities (91.7%), risk factors could be identified (atherosclerotic vessel wall disease, vasculitis, hypercoagulable states). Experienced neuroradiologists performed 21 of 48 angiographies (43.8%) on patients with the above-mentioned risk factors, whereas junior neuroradiologists performed 27 angiographies in this subgroup (46.2%). The rate of diffusion abnormalities in patients with risk factors was 11/48 (22.9%)—considerably higher than in patients without risk factors (1/59; 1.7%).

Conclusion

The level of experience and the nature of the underlying disease are predictors of the occurrence of cerebral ischemic events following neuroangiography. Alternative diagnostic modalities should be employed in patients who are investigated for diseases with the highest risk of angiographic complications (i.e., vasculitis, and arteriosclerotic vessel wall disease). If diagnostic angiography remains necessary in these patients, the highest level of practitioner training is necessary to ensure good patient outcome.

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Acknowledgements

We would like to thank two anonymous reviewers for their helpful suggestions and discussions.

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We declare that we have no conflict of interest.

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Correspondence to T. Krings.

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Krings, T., Willmes, K., Becker, R. et al. Silent microemboli related to diagnostic cerebral angiography: a matter of operator’s experience and patient’s disease. Neuroradiology 48, 387–393 (2006). https://doi.org/10.1007/s00234-006-0074-3

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  • DOI: https://doi.org/10.1007/s00234-006-0074-3

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