Safety of cerebral digital subtraction angiography in children: complication rate analysis in 241 consecutive diagnostic angiograms.
OBJECTIVE
Catheter-based cerebral angiography remains an important diagnostic tool in the pediatric population, particularly considering the currently growing interest in diagnosing and treating cerebrovascular disorders in children. There are no recent estimates of the complication rate associated with modern diagnostic digital subtraction angiography (DSA) in the pediatric population. The purpose of this study was to estimate the rate of complications occurring during cerebral angiography in children.


METHODS
Data from 241 consecutive pediatric cerebral angiograms performed at a single institution were entered into an institutional review board-approved database. Information on patient demographics, DSA indication, neurovascular diagnosis, and intra procedural and postprocedural complications was collected.


RESULTS
Our population included 115 boys and 90 girls, with age ranging from 1 week to 18 years (mean+/-SD, 12+/-5 years). All angiograms were technically successful. No intraprocedural complication was noted; in particular, there was no occurrence of iatrogenic vessel injury (dissection) and no transient or permanent neurological deficit secondary to a thromboembolic event. One child with a complex dural arteriovenous fistula experienced a fatal intracranial rehemorrhage secondary to a posterior fossa varix rupture 3 hours after completion of an uneventful diagnostic angiogram. The rates of intraprocedural and postprocedural complications were therefore 0.0% (95% CI, 0.0% to 1.4%) and 0.4% (95% CI, 0.012% to 2.29%), respectively.


CONCLUSIONS
The rate of immediate complications occurring during diagnostic cerebral angiography in children is very low. No intraprocedural complication was documented in the reported series. DSA performed by experienced angiographers is a safe procedure that can provide critical diagnostic information.
Burger
Ingrid M
IM
Division of Interventional Neuroradiology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
Murphy
Kieran J
KJ
Jordan
Lori C
LC
Tamargo
Rafael J
RJ
Gailloud
Philippe
P
D000293:Adolescent; D000654:Amobarbital / Q000008:administration & dosage / Q000009:adverse effects; D015901:Angiography, Digital Subtraction / Q000009:adverse effects* / Q000706:statistics & numerical data; D002404:Catheterization / Q000009:adverse effects; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging; D002543:Cerebral Hemorrhage / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000009:adverse effects; D016208:Databases, Factual; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007269:Injections, Intra-Arterial; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging; D008297:Male
D003287:Contrast Media; D000654:Amobarbital