Heparin and air filters reduce embolic events caused by intra-arterial cerebral angiography: a prospective, randomized trial.
BACKGROUND
Intra-arterial cerebral angiography is associated with a low risk for neurological complications, but clinically silent ischemic events after angiography have been seen in a substantial number of patients.


RESULTS
In a prospective study, diffusion-weighted magnetic resonance imaging (DW-MRI) before and after intra-arterial cerebral angiography and transcranial Doppler sonography during angiography were used to evaluate the frequency of cerebral embolism. One hundred fifty diagnostic cerebral angiographies were randomized into 50 procedures, each using conventional angiographic technique, or systemic heparin treatment throughout the procedure, or air filters between the catheter and both the contrast medium syringe and the catheter flushing. There was no neurological complication during or after angiography. Overall, DW-MRI revealed 26 new ischemic lesions in 17 patients (11%). In the control group, 11 patients showed a total of 18 lesions. In the heparin group, 3 patients showed a total of 4 lesions. In the air filter group, 3 patients exhibited a total of 4 lesions. The reduced incidence of ischemic events in the heparin and air filter groups compared with the control group was significantly different (P=0.002). Transcranial Doppler sonography demonstrated a large number of microembolic signals that was significantly lower in the air filter group compared with the heparin and control groups (P<0.01), which did not differ from each other.


CONCLUSIONS
Air filters and heparin both reduce the incidence of silent ischemic events detected by DW-MRI after intra-arterial cerebral angiography and can potentially lower clinically overt ischemic complications. This may apply to any intra-arterial angiographic procedure.
Department of Neuroradiology, University of Würzburg, Josef-Schneider-Strasse 11, D-97080 Würzburg, Germany. bendszus@neuroradiologie.uni-wuerzburg.de
Martin
M
Bendszus
Martin
M
Koltzenburg
Andreas J
AJ
Bartsch
Roland
R
Goldbrunner
Thomas
T
Günthner-Lengsfeld
Franz X
FX
Weilbach
Klaus
K
Roosen
Klaus V
KV
Toyka
László
L
Solymosi
D000328:Adult; D000368:Aged; D000388:Air; D015901:Angiography, Digital Subtraction / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D002533:Cerebral Angiography / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D038524:Diffusion Magnetic Resonance Imaging; D004618:Embolism, Air / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005374:Filtration; D005471:Fluoroscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D017585:Ultrasonography, Doppler, Transcranial
D000925:Anticoagulants; D006493:Heparin