Carotid and cerebral angiography performed by cardiologists: Cerebrovascular complications

Abstract

The management of extracranial carotid artery disease is primarily concerned with the prevention of acute stroke. In order to understand the current risks of carotid angiography performed by interventional cardiologists, we undertook a retrospective study to determine the neurologic complications in patients who underwent selective cerebral angiography. All patients undergoing studies that were limited to diagnostic aortic arch angiography and selective four-vessel cerebral angiography in the cardiac catheterization laboratories during the past 6 years were included in this study. Hospital records were reviewed to determine any in-hospital cerebrovascular complications following carotid angiography, ranging from transient ischemic attack to major disabling stroke or death. A total of 189 consecutive patients underwent 191 diagnostic studies limited to aortic arch and four-vessel cerebral angiography in the cardiac catheterization laboratories between 1 January 1995 and 31 December 2000. Only one (0.52%) neurological complication, a minor stroke, occurred in our study population. There were no transient ischemic attacks, major strokes, or death. We have shown that experienced interventional cardiologists can perform diagnostic aortic arch and selective carotid and vertebral angiography in a cardiac catheterization laboratory with a very low complication rate. Because the risks of angiography add to those of revascularization of the carotid artery, the most highly skilled angiographer, regardless of primary specialty, should perform these studies.

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease

“…218 -225 Substantially higher rates of stroke have been reported with diagnostic angiography in some series, most notably in ACAS, 71 in which the incidence was 1.2% because of unusually frequent complications at a few centers. Complication rates in other studies have been substantially lower, 226 and most authorities regard a stroke rate Ͼ1% with diagnostic angiography as unacceptable. 227 Angiography may be the preferred method for evaluation of ECVD when obesity, renal dysfunction, or indwelling ferromagnetic material renders CTA or MRA technically inadequate or impossible, and angiography is appropriate when noninvasive imaging studies produce conflicting results.…”

ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting

“…In asymptomatic patients in the ACAS trial, stroke occurred in 1.2% of patients after angiography (22). More recent studies reported neurological complication rates in less than 1% of patients, suggesting that the risk may be lower than previously reported (90,91). Possible explanations for these differences are improvements in equipment, technique, and operator experience; monitoring of cathetertip pressure during angiography; and use of procedural heparin and antiplatelet agents.…”

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease

“…Substantially higher rates of stroke have been reported with diagnostic angiography in some series, most notably in ACAS (71), in which the incidence was 1.2% because of unusually frequent complications at a few centers. Complication rates in other studies have been substantially lower (226), and most authorities regard a stroke rate Ͼ1% with diagnostic angiography as unacceptable (227). Angiogra- phy may be the preferred method for evaluation of ECVD when obesity, renal dysfunction, or indwelling ferromagnetic material renders CTA or MRA technically inadequate or impossible, and angiography is appropriate when noninvasive imaging studies produce conflicting results.…”