title: Safety of neuroangiography and embolization in children: complication analysis of 697 consecutive procedures in 394 patients.
abstract: OBJECTIVE
  The safe treatment of children using catheter-based angiography and embolization poses unique challenges because of the technical factors regarding the size and fragility of access and target vessels, as well as unique pediatric cerebrovascular pathologies. The complication rates for neurointerventional procedures in children have not been established.
  
  
  METHODS
  The records of a consecutive cohort of pediatric patients who underwent neuroangiography and/or embolization between 2007 and 2013 were reviewed retrospectively to identify both intraprocedural and postprocedural complications. Demographic and clinical risk factors were analyzed with a multivariate logistic regression model.
  
  
  RESULTS
  The 697 consecutive procedures consisted of 429 diagnostic angiograms and 268 embolizations (mean age of patients 11.1 years; range 4 days to 18 years; 217 females). There were 130 intracranial, 122 extracranial, and 16 spinal embolizations. Pathologies included 28 intracranial arteriovenous malformations (AVMs), 12 spinal AVMs, 19 aneurysms, 29 vein of Galen malformations, 29 dural arteriovenous fistulas, 96 extracranial AVMs, 39 tumors, 3 strokes, and 13 others. Overall, 2 intraprocedural and 1 postprocedural complication (0.7%) occurred in the diagnostic group, all of which were nonneurological events. In the embolization group, 7 intraprocedural and 11 postprocedural complications (6.7%) were observed. Of these complications, 15 were nonneurological events (5.6%), 1 was a short-term neurological event (0.4%), and 2 were long-term neurological events (0.7%).
  
  
  CONCLUSIONS
  Neither the technical challenges posed by children's access and target vessels nor the unique neuro-vascular pathologies seen in children need result in an elevated morbidity rate related to neuroangiography and embolization. At a dedicated high-volume center, the complication rates may be lower than those for comparable procedures performed in adults.
authors.affiliation: Department of Neurosurgery, Weill Cornell Medical Center, New York, New York; and.|Department of Neurosurgery and.
authors.forename: Ning
authors.initials: N
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery and.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Smith
authors.affiliation: Department of Neurosurgery and.
authors.forename: R Michael
authors.initials: RM
authors.lastname: Scott
authors.affiliation: Division of Interventional and Neurointerventional Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Darren B
authors.initials: DB
authors.lastname: Orbach
mesh_terms: D000293:Adolescent; D001919:Bradycardia / Q000209:etiology; D001925:Brain Damage, Chronic / Q000209:etiology; D001932:Brain Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging; D002404:Catheterization / Q000009:adverse effects / Q000379:methods; D002533:Cerebral Angiography / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D002543:Cerebral Hemorrhage / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D004868:Equipment Failure; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging; D020766:Intracranial Embolism / Q000209:etiology; D008297:Male; D009366:Neoplasm Seeding; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging
keywords: AVF = arteriovenous fistula; AVM = arteriovenous malformation; DSA = digital subtraction angiography; VOGM = vein of Galen malformation; cerebral angiography; complication analysis; neurointervention; pediatric vascular disorders