Journal Article

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

Bendszus, Martin, Warmuth-Metz, Monika, Koltzenburg, Martin, Burger, Ralph, Solymosi, Laszlo, Hofmann, Erich

1999

Overview

Cerebral angiography is associated with a small but definite risk of neurological complications with an unknown incidence of clinically silent embolism. We assessed the neurological complication rate compared with the frequency of silent embolism after angiography We used diffusion-weighted magnetic resonance imaging (MRI) before and after angiography to assess embolic events. 100 consecutive angiographies (66 diagnostic and 34 interventional procedures) were done on 91 patients. Patients underwent neurological assessment before, immediately after, and 1 day after angiography. Before angiography, no abnormalities were seen on diffusion-weighted MRI. Diffusion-weighted MRI showed 42 bright lesions in 23 patients after 23 procedures (17 diagnostic, six interventional) in a pattern consistent with embolic events. There was no new neurological deficit after any angiographic procedure. After diagnostic angiography in patients with a history of vasculopathy, the frequency of lesions was significantly higher than in patients without vascular risk factors (12 [44%] of 27 vs five [13%] of 39 patients, p=0·03). In diagnostic angiography, the appearance of lesions was significantly correlated with whether vessels were difficult to probe (p=0·01), amount of contrast medium needed (p<0·01), fluoroscopy time (p<0·01), and use of additional catheters (p=0·02). After diagnostic and interventional cerebral angiography, embolic events are more frequent than the apparent neurological complication rate. In diagnostic procedures, the incidence of embolism is closely related to a vascular risk profile.

• Publisher: Elsevier Ltd,Lancet,Elsevier Limited
• Subject: Adolescent / Adult / Aged / Aged, 80 and over / Biological and medical sciences / Blood vessels / Brain damage / Cerebral Angiography - adverse effects / Child / Female / Humans / Intracranial Embolism and Thrombosis - diagnosis / Intracranial Embolism and Thrombosis - etiology / Investigative techniques, diagnostic techniques (general aspects) / Magnetic Resonance Imaging / Male / Medical disorders / Medical sciences / Middle Aged / Nervous system / Neurological complications / Neurology / NMR / Nuclear magnetic resonance / Postoperative Complications - epidemiology / Radiodiagnosis. Nmr imagery. Nmr spectrometry / Radiography, Interventional / Surgery