Complications following transfemoral cerebral angiography for cerebral ischemia. Report of 159 Angiograms and Correlation with Surgical Risk

Theodotou, Basil; Whaley, Robert A.; Mahaley, M. S.

doi:10.1016/0090-3019(87)90078-4

Cited by 43 publications

(23 citation statements)

References 8 publications

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“…21 Some of these features (such as carotid artery disease, 21 TLA and strokein-evolution, 28 and frequent TIAs and recent stroke 17 ) also showed a trend in other studies toward predicting an increased incidence of complications from cerebral angiography while other similar trends were noted with patients of greater age, 20 those in general ill health and with systemic disease, 29 a greater number of catheters used and catheter exchanges, 17 -20 and longer duration of the procedure. 20 It is noteworthy that the use of nonionic compared with ionic contrast did not appreciably affect the complication rate.…”

Section: What Causes the Complications Of Cerebral Angiography?mentioning

confidence: 81%

“…Theodotou et al 28 examined 159 cerebral angiograms from 152 patients with carotid stenosis who later had a carotid endarterectomy. The mean age of the patients was 63 years.…”

Section: Thomson and Thomsonmentioning

confidence: 99%

“…The potential risk factors for complications following cerebral angiography identified as statistically significant in any study reviewed were the patients considered (i.e., those with cerebrovascular disease as opposed to those with other neurologic disorders having cerebral angiography) for both local and neurologic complications, 20 stroke-in-evolution, 28 increasing number of previous TIAs, 24 carotid arterial stenosis of >90%, 24 bilateral severe carotid stenosis, 28 greater volume of contrast administered, 20 and cerebral angiography performed by inexperienced radiology trainees. 21 Some of these features (such as carotid artery disease, 21 TLA and strokein-evolution, 28 and frequent TIAs and recent stroke 17 ) also showed a trend in other studies toward predicting an increased incidence of complications from cerebral angiography while other similar trends were noted with patients of greater age, 20 those in general ill health and with systemic disease, 29 a greater number of catheters used and catheter exchanges, 17 -20 and longer duration of the procedure.…”

Section: What Causes the Complications Of Cerebral Angiography?mentioning

confidence: 99%

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Cerebral angiographic risk in mild cerebrovascular disease.

Hankey

Warlow

Sellar

1990

Stroke

443

161

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We review the eight prospective and seven retrospective studies from which it is possible to derive the complication rate of conventional cerebral angiography for patients with mild ischemic cerebrovascular disease who are potential candidates for carotid endarterectomy. Three studies of intravenous and one of intra-arterial digital subtraction angiography are also examined. An overview of the results suggests that the risk of a neurological complication (TIA or stroke) is about 4% and that a permanent neurological deficit (disabling stroke) occurs in about 1%. The mortality rate is very low (<0.1%). Systemic complications are not infrequent, particularly with intravenous digital subtraction angiography. The complication rate of cerebral angiography must be considered when evaluating the risks of carotid endarterectomy in patients with ischemic cerebrovascular disease. (Stroke 1990;21:209-222)

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Section: What Causes the Complications Of Cerebral Angiography?mentioning

confidence: 81%

“…Theodotou et al 28 examined 159 cerebral angiograms from 152 patients with carotid stenosis who later had a carotid endarterectomy. The mean age of the patients was 63 years.…”

Section: Thomson and Thomsonmentioning

confidence: 99%

Section: What Causes the Complications Of Cerebral Angiography?mentioning

confidence: 99%

See 1 more Smart Citation

Cerebral angiographic risk in mild cerebrovascular disease.

Hankey

Warlow

Sellar

1990

Stroke

443

161

View full text Add to dashboard Cite

show abstract

“…Patients older than 60 years and those with cerebrovascular disease, especially transient ischemic attacks and recent or evolving stroke, have a substantially higher risk of new or worsened neurological symptoms after angiography. [15][16][17][18] Theodotou et al 18 found a 4.5% risk in patients with transient ischemic attacks, which increased to 7.7% in patients with evolving stroke. We observed that the complication rate associated with diagnostic angiography using new hydrophilic catheters was very low.…”

Section: Discussionmentioning

confidence: 99%

Role of Conventional Angiography in Evaluation of Patients With Carotid Artery Stenosis Demonstrated by Doppler Ultrasound in General Practice

Qureshi

Suri

Ali

et al. 2001

Stroke

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Background and Purpose-Previous studies have suggested that patients with carotid stenosis who are candidates for endarterectomy can be effectively identified on the basis of carotid Doppler ultrasound alone. Before widespread acceptance of this policy, the accuracy of carotid Doppler ultrasound outside selected centers and clinical trials needs to be evaluated. We performed a 12-month prospective study to evaluate the accuracy of Doppler ultrasound in identifying patients for carotid intervention in general practice settings. Methods-Each patient referred to our endovascular service for diagnostic angiography to evaluate for carotid stenosis was interviewed and examined by a neurologist. Subjects consisted of symptomatic patients with Ն50% stenosis and asymptomatic patients with Ն60% stenosis by Doppler ultrasound. Information pertaining to demographic and cerebrovascular risk factors and the results of the carotid Doppler ultrasound were recorded. The severity of stenosis on angiograms was measured with North American Symptomatic Carotid Endarterectomy Trial criteria by a blinded observer. The results of both studies were compared to determine the relative accuracy of ultrasound results. Results-Of 130 patients (mean age, 69Ϯ8.8 years) who met Doppler ultrasound criteria, 22 (17%) and 8 patients (6%)were found to have 30% to 49% or Ͻ30% stenosis by angiography, respectively. The positive predictive value of carotid Doppler ultrasound for identifying appropriate symptomatic candidates for carotid intervention (angiographic stenosis Ն50%) was 80%, with a false-positive value of 20%. The positive predictive value of carotid Doppler ultrasound for identifying appropriate asymptomatic candidates for carotid intervention (angiographic stenosis Ն60%) was 59%, with a false-positive value of 41%. Carotid endarterectomy or angioplasty and stent placement were undertaken subsequently in 60 (46%) of the patients. In 94 patients who underwent cerebral angiography alone, no complications were observed. Conclusions-The present accuracy of carotid Doppler ultrasound in general practice does not justify its use as the sole basis of selecting appropriate patients for carotid intervention. Given the relatively low rate of associated morbidity with present day techniques, additional confirmatory studies such as angiography should be performed in every patient before a decision regarding intervention is made.

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“…It is expen sive, requires extensive physician involvement, and is an invasive procedure. The rate of complications, including stroke, ranges from 1.2 to 7.7% [26,27], Arteriography visualizes only the vascular lumen and intramural arterial abnormalities can be missed. Arteriography remains an important component of the investigation of ischemic stroke in young adults, those with atypical stroke syn drome, and those who may require operation.…”

Section: Arteriographymentioning

confidence: 99%

Investigation of the Patient with Ischemic Stroke

Adams¹

1991

Cerebrovasc Dis

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Evaluation of a patient with recent stroke is divided into studies that confirm the diagnosis of an ischemic event and those that determine the most likely etiology. While clinical manifestations of hemorrhagic and ischemic stroke overlap, imaging studies (computed tomography, CT, or magnetic resonance imaging, MRI) effectively differentiate these disorders. Imaging studies also define the site and extent of the stroke and provide evidence towards its etiology and prognosis. Imaging also detects complications of stroke or therapy including edema, hydrocephalus or hemorrhagic infarction. MRI also detects very acute, small or posterior fossa infarctions that can be missed by CT. MRI can also detect arterial-flow abnormalities. The role of transcranial Doppler or Duplex imaging in acute ischemic stroke has not been defined. While atherosclerosis is the most common cause of cerebral ischemia, a number of diseases present with or are complicated by stroke. Investigation for the etiology of stroke is justified particularly in patients with atypical presentations. Arteriography is warranted in most patients but may, in the future, be replaced by MRI angiography. Specialized hematologic studies for evaluation of hypercoagulable states are indicated. Transthoracic echocardiography can be supplemented by Doppler or contrast techniques. Transesophageal echocardiography effectively visualizes the left atrium and atrial appendage. Ultrafast CT imaging of the heart may add valuable information in screening patients with stroke.

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Complications following transfemoral cerebral angiography for cerebral ischemia. Report of 159 Angiograms and Correlation with Surgical Risk

Cited by 43 publications

References 8 publications

Cerebral angiographic risk in mild cerebrovascular disease.

Cerebral angiographic risk in mild cerebrovascular disease.

Role of Conventional Angiography in Evaluation of Patients With Carotid Artery Stenosis Demonstrated by Doppler Ultrasound in General Practice

Investigation of the Patient with Ischemic Stroke

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