Neurological morbidity of arch and carotid arteriography in cerebrovascular disease. The influence of contrast medium and radiologist

Abstract

A prospective study of 230 arch and carotid arteriograms in 229 patients with symptomatic cerebrovascular disease revealed that neurological morbidity was not significantly affected by patient age, nature of neurological symptoms, duration of procedure, volume of contrast medium or degree of arterial stenosis. The total neurological morbidity of 132 examinations carried out with non-ionic contrast medium (iohexol) was slightly lower than that of 98 examinations carried out with ionic contrast medium (meglumine and sodium iothalamate) but the difference was not statistically significant. However, the morbidity of 185 examinations performed by an experienced vascular radiologist was significantly lower (p less than 0.025) than the morbidity of 45 examinations performed by a series of radiologists in training and the mean time required for the procedure was 18 min longer in the latter group (p less than 0.001). These findings suggest that the neurological morbidity of arch and carotid arteriography in patients with cerebrovascular disease depends largely upon catheter technique and will not be significantly reduced by the use of non-ionic contrast medium.

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

“…Other potential complications include arterial dissections related to the catheter or glidewire, air embolism, platelet activation, 12 and neurotoxicity of contrast agents. 13,14 These concerns led to our use of nonionic contrast material; small catheters; and a closed, continuously antegrade flushing system to prevent air embolism. Arch aortographies are associated with higher neurologic complication rates 14,15 and require a large contrast load (50 mL).…”

“…13,14 These concerns led to our use of nonionic contrast material; small catheters; and a closed, continuously antegrade flushing system to prevent air embolism. Arch aortographies are associated with higher neurologic complication rates 14,15 and require a large contrast load (50 mL). Therefore, we very rarely perform such arch aortograms, and none were performed in this series.…”

Training, competency, and credentialing standards for diagnostic cervicocerebral angiography, carotid stenting, and cerebrovascular intervention

“…5,[7][8][9][10][11][12][13][14][15][16][17][18][19][20] Experienced neurovascular specialists may have complication rates lower than 1%. 20 There is additional risk of temporary neurological deficit ranging from 0.3-6.8% with, on average, a 2-3 fold increased risk of temporary as compared to permanent neurological deficit.…”

“…20 There is additional risk of temporary neurological deficit ranging from 0.3-6.8% with, on average, a 2-3 fold increased risk of temporary as compared to permanent neurological deficit. [7][8][9][10][11][12][13][14][15][16][17][18][19][20] Patients with atherosclerotic cerebrovascular disease as manifested by neurological symptoms (ipsilateral transient ischemic attack [TIA] or stroke) have a 2-3 fold higher risk of stroke from diagnostic cerebral angiography (0.5-5.7% risk of permanent deficit) as compared to asymptomatic lesions (0.1-1.2% risk). [5][6][7][8][9][10][15][16][17][18][19][20] In one study, 1000 consecutive patients undergoing diagnostic cerebral angiography were assessed for procedure-related neurological deficits.…”

S3-Leitlinie Extracranielle Carotisstenose

“…So konnte z. B. in einer Analyse von 5.000 Angiographien gezeigt werden, dass erfahrene und gut ausgebildete Untersucher eine signifikante geringere neurologische Komplikationsrate (0,5%) im Vergleich zu Ausbildungsärzten unter Supervision hatten [7,8]. Aufgrund der schnelleren und sicheren Sondierung der supraaortalen Gefäßabgänge am Aortenbogen konnte hierbei nicht nur die Komplikationsrate, sondern auch die Durchleuchtungszeiten signifikant gesenkt werden [9].…”