Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: a prospective study

Bendszus, Martin; Koltzenburg, M; Burger, Ralf; Warmuth‐Metz, Monika; Hofmann, Erich; Solymosi, L.

doi:10.1016/s0140-6736(99)07083-x

Cited by 453 publications

(347 citation statements)

References 11 publications

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“…New ischemic lesions occurred in 29% of 59 patients after diagnostic angiography, and the frequency of lesions was correlated to the amount of contrast medium, timing of the procedure, number of vessels difficult to probe, and use of more than one catheter. 5) The upper boundary of 9% abnormalities associated with angiography is supported by diffusion-weighted imaging of asymptomatic patients, 6) and 69.2% of lesions in our study were located in the vascular territory of the treated carotid artery, suggesting that microembolism may occur at any time during CAS.…”

Section: Discussionsupporting

confidence: 65%

Cerebral Ischemic Lesions Detected With Diffusion-Weighted Magnetic Resonance Imaging After Carotid Artery Stenting: Comparison of Several Anti-embolic Protection Devices

Taha

Maeda

Sakaida

et al. 2009

Neurol. Med. Chir.(Tokyo)

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Distal embolism is an important periprocedural technical complication with carotid angioplasty and carotid artery stenting (CAS). We evaluated the safety and efficacy of protection devices used during CAS by detecting new cerebral ischemic lesions using diffusion-weighted magnetic resonance imaging in 95 patients who underwent 98 CAS procedures: 34 using single PercuSurge GuardWire, 31 using double balloon protection, 15 using proximal flow reverse protection devices, 14 using Naviballoon, and 4 using filter anti-embolic devices. Diffusion-weighted imaging was performed preoperatively and postoperatively to evaluate the presence of any new embolic cerebral lesions. Postoperative diffusionweighted imaging revealed 117 new ischemic lesions. Three patients had new ischemic stroke, two minor and one major, all ipsilateral to the treated carotid artery. The remaining patients had clinically silent ischemia. The incidence of new embolic lesions was lower using the proximal flow reverse protection device than with the double balloon protection (33% vs. 48.4%), but the volume of ipsilateral new ischemic lesions per patient was 136.6 mm 3 vs. 86.9 mm 3 , respectively. Neuroprotection with Naviballoon yielded ipsilateral lesions of large volume (86.6 mm 3 ) and higher number (5.7 lesions per patient) than using the filter anti-embolic device (34.8 mm 3 and 1 lesion per patient). New cerebral ischemic lesions after neuroprotected CAS are usually silent. The lower incidence of distal ischemia using proximal flow reverse and double balloon protection devices is limited by the larger volume and higher number of ischemic lesions.

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Section: Discussionsupporting

confidence: 65%

Cerebral Ischemic Lesions Detected With Diffusion-Weighted Magnetic Resonance Imaging After Carotid Artery Stenting: Comparison of Several Anti-embolic Protection Devices

Taha

Maeda

Sakaida

et al. 2009

Neurol. Med. Chir.(Tokyo)

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Section: Discussionmentioning

confidence: 99%

“…1,2,14) The amount of contrast medium used, fluoroscopic time, and use of additional catheters were risk factors for the detection of HIL on DWI after cerebral angiography. 1) The results of occlusion tests of the internal carotid arteries were significantly correlated with the appearance of HIL on DWI. 14) Additionally, a history of stroke and transient ischemic attack were more highly correlated with neurological complication after angiogra- Risk Factors of Ischemic Lesions in Angiography phy.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports have indicated that incidental embolism is not rare, and past history of vasculopathy, amount of contrast medium used, fluoroscopy time, use of additional catheters, procedures of the occlusion test, and performance of endovascular surgery for cerebrovascular disease are risk factors for embolism. 1,4,5,8,9,11,13,16,17,20,21) Angiography of the coronary arteries also carries a risk for cerebral embolism due to the duration of the procedure. 4,15) Diffusion-weighted MR imaging (DWI) allows for the most sensitive early detection of cerebral ischemia within minutes of onset.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors of Ischemic Lesions Related to Cerebral Angiography and Neuro-interventional Procedures

Sato

Nakai

Tsurushima

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Embolic stroke is not a rare complication of cerebral angiography. The risk factors for incidental embolism after cerebral angiography were retrospectively examined using diffusion-weighted magnetic resonance imaging (DWI) in 180 patients who underwent 247 angiography procedures, consisting of 174 diagnostic angiography and 73 interventional procedures, and magnetic resonance imaging including DWI within 72 hours after angiography. The two neuroradiologists in our hospital detected embolism after cerebral angiography as high-intensity lesions (HIL) on DWI. The relationships between HIL on DWI and procedural factors were evaluated. DWI after cerebral angiography revealed HIL related to the procedure in 72 of 247 angiographies. In all procedures, age (p º 0.01), past history of cerebral infarction (p º 0.05), anti-platelet therapy (p º 0.05), neuro-intervention (p º 0.01), and total amount of contrast medium (odds ratio [OR] 2.125, 95% confidence interval [CI] 1.045-4.321) were significantly correlated with HIL. In diagnostic angiography, the performance of the procedure by a resident operator (OR 2.526, 95% CI 1.214-5.254) was significantly correlated with HIL. Age, past history of cerebral infarction, and previous anti-platelet therapy determined the risk of atherosclerotic changes in patients. The neuro-intervention and total amount of contrast medium used could predict the risk of time limitations for angiography. Resident operator is also a risk factor. This study demonstrates the importance of improving the risk of time limitations for angiography and the risk due to operator inexperience. Further training of residents may be needed to reduce the occurrence of embolic complications.

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“…44,45 Few DWI studies have examined the issue of silent cerebral ischemia after endovascular procedures. A recent study by Bendszus et al 46 examined the occurrence of silent embolism in diagnostic and interventional cerebral angiography. Among 100 consecutive angiographic procedures, brain DWI showed 42 hyperintense lesions consistent with cerebral embolism in 23 patients.…”

Section: Discussionmentioning

confidence: 99%

Silent Cerebral Ischemia Detected by Diffusion-Weighted MRI After Carotid Endarterectomy

Barth

Remonda

Lövblad

et al. 2000

Stroke

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Background and Purpose-Small emboli arising from a friable plaque during carotid endarterectomy (CEA) constitute an important risk of perioperative ischemic complications. To evaluate the incidence and significance of silent cerebral ischemic lesions of embolic origin after CEA, we prospectively examined a series of surgical patients with high-grade carotid stenosis by using diffusion-weighted MRI (DWI). We also tried to correlate postoperative ischemic lesions with the occurrence of sonographic cerebral embolic signals, the presence of plaque ulcerations, and the use of intraoperative shunting. Methods-Of a consecutive series of 53 patients undergoing elective CEA for high-grade carotid stenosis, 48 patients with unchanged postoperative neurological status were prospectively studied with DWI of the brain the day before and the day after the operation. The magnetic resonance images were analyzed by 2 neuroradiologists blinded to the clinical result of the operation. Any new hyperintense signal was interpreted as a postoperative ischemic lesion. Results-Forty-six (95.8%) of 48 patients had unchanged postoperative brain DWI. In 2 patients (4.2%), a new single asymptomatic hyperintense signal was observed on the side of the operation. Both lesions were small and presumably of embolic origin. They were not related to sonographic embolic signals, plaque ulcerations, or intraoperative shunting. Conclusions-These results suggest that the incidence of silent ischemic brain lesions of embolic origin after CEA is low and does not correlate with the occurrence of intraoperative sonographic microemboli. They confirm that CEA is a safe procedure that carries a low risk of postoperative cerebral events. (Stroke. 2000;31:1824-1828.)

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Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: a prospective study

Cited by 453 publications

References 11 publications

Cerebral Ischemic Lesions Detected With Diffusion-Weighted Magnetic Resonance Imaging After Carotid Artery Stenting: Comparison of Several Anti-embolic Protection Devices

Cerebral Ischemic Lesions Detected With Diffusion-Weighted Magnetic Resonance Imaging After Carotid Artery Stenting: Comparison of Several Anti-embolic Protection Devices

Risk Factors of Ischemic Lesions Related to Cerebral Angiography and Neuro-interventional Procedures

Silent Cerebral Ischemia Detected by Diffusion-Weighted MRI After Carotid Endarterectomy

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