Complications of modern diagnostic cerebral angiography in an academic medical center.
OBJECTIVE
Catheter cerebral angiography and noninvasive cerebral imaging have steadily improved in the past several decades. Now, catheter angiography is frequently reserved for treatment planning. To remain relevant as a diagnostic modality, catheter angiography must be safe, even in critically ill patients. The present report describes the complication rate of catheter cerebral angiography performed by neurointerventional specialists at an academic medical center.


METHODS
From July 2001 through June 2007, 3,636 diagnostic catheter cerebral angiograms were obtained at a large academic institution. Complication data were prospectively acquired according to institutional policy and New York Patient Occurrence Reporting and Tracking System criteria. Data collected included patient age, sex, indication for the procedure, operator, and nature of adverse event, including need for treatment. Clinical predictors of complications were evaluated with logistic regression.


RESULTS
Among 3,636 diagnostic cerebral angiograms obtained in 6 years, there were 11 clinical complications (0.30%). One patient (0.03%) had magnetic resonance imaging-detected stroke with no apparent clinical deterioration. Iatrogenic dissections were seen in five arteries (0.14%). No patient developed neurologic symptoms. Nonneurologic complications occurred in five patients (0.14%) who had arteriotomy site-related complications: one femoral abscess, two occlusions of the femoral artery with leg ischemia requiring surgical revascularization, one dissection with pseudoaneurysm formation requiring percutaneous thrombin injection, and one retroperitoneal hemorrhage requiring transfusion. Three of these patients were treated with an arterial closure device. Age greater than 65 years was associated with development of complications (P = .03).


CONCLUSIONS
Modern catheter cerebral angiography performed by neurointerventionalists is associated with a low complication rate of 0.30%, even in a highly complex patient population.
Fifi
Johanna T
JT
Department of Radiology, New York-Presbyterian Hospitals, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. jtfifi@gmail.com
Meyers
Philip M
PM
Lavine
Sean D
SD
Cox
Virginia
V
Silverberg
Lynn
L
Mangla
Sundeep
S
Pile-Spellman
John
J
D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000453:epidemiology / Q000209:etiology; D001157:Arterial Occlusive Diseases / Q000453:epidemiology / Q000209:etiology; D015984:Causality; D002533:Cerebral Angiography / Q000009:adverse effects* / Q000706:statistics & numerical data*; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology; D015897:Comorbidity; D005260:Female; D005263:Femoral Artery; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D015641:Radiography, Interventional / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology