Neurologic Complications of Cerebral Angiography: Prospective Analysis of 2,899 Procedures and Review of the Literature

PURPOSE: To prospectively identify risk factors for neurologic complications related to cerebral angiography.

MATERIALS AND METHODS: A total of 2,899 consecutive cerebral digital subtraction angiograms obtained with nonionic contrast material were prospectively evaluated. Neurologic complications were categorized as transient (<24 hours), reversible (24 hours to 7 days), and permanent (>7 days). The neurologic complication rate was correlated with patient age, type of indication for catheter angiography, medical history, fluoroscopic time, number and size of catheters, type and number of vessels injected, operator experience, and the quartile in which the study was performed. The correlations were statistically analyzed with Fisher exact tests and a multiple logistic regression model.

RESULTS: There were 39 (1.3%) neurologic complications in 2,899 procedures; 20 were transient (0.7%), five (0.2%) were reversible, and 14 (0.5%) were permanent. Neurologic complications were significantly more common in patients 55 years of age or older (25 of 1,361; 1.8%) (P = .035), in patients with cardiovascular disease (CVD) (20 of 862; 2.3%) (P = .004), and when fluoroscopic times were 10 minutes or longer (24 of 1,238; 1.9%) (P = .022). The neurologic complication rate was higher in procedures performed by fellows alone (24 of 1,878; 1.3%) compared with that when staff alone performed the procedures (three of 598; 0.5%), but the difference was not significant (P = .172). Neurologic complications were lower in the fourth quartile of the study (six of 171; 0.9%) compared with the first quartile (16 of 776; 2.1%), which was likely due to fewer patients being examined for carotid stenosis or ischemic stroke and fewer patients with CVD (P = .085).

CONCLUSION: Age-related vascular disease accounted for the failure to lower the neurologic complication rate of cerebral angiography despite technical advances.

© RSNA, 2003

References

  • 1 Farb RI, McGregor C, Kim JK, et al. Intracranial arteriovenous malformations: real-time auto-triggered elliptic centric-ordered 3D gadolinium-enhanced MR angiography—initial assessment. Radiology 2001; 220:244-251. LinkGoogle Scholar
  • 2 White PM, Teasdale EM, Wardlaw JM, Easton V. Intracranial aneurysms: CT angiography and MR angiography for detection prospective blinded comparison in a large patient cohort. Radiology 2001; 219:739-749. LinkGoogle Scholar
  • 3 Randoux B, Marro B, Koskas F, et al. Carotid artery stenosis: prospective comparison of CT, three-dimensional gadolinium-enhanced MR, and conventional angiography. Radiology 2001; 220:179-185. LinkGoogle Scholar
  • 4 Munera F, Soto JA, Palacio D, Velez SM, Medina E. Diagnosis of arterial injuries caused by penetrating trauma to the neck: comparison of helical CT angiography and conventional angiography. Radiology 2000; 216:356-362. LinkGoogle Scholar
  • 5 Skalpe IO. Complications in cerebral angiography with iohexol (Omnipaque) and meglumine metrizoate (Isopaque cerebral). Neuroradiology 1988; 30:69-72. Crossref, MedlineGoogle Scholar
  • 6 Waugh JR, Sacharias N. Arteriographic complications in the DSA era. Radiology 1992; 182:243-246. LinkGoogle Scholar
  • 7 Grzyska U, Freitag J, Zeumer H. Selective cerebral intraarterial DSA: complication rate and control of risk factors. Neuroradiology 1990; 32:296-299. Crossref, MedlineGoogle Scholar
  • 8 Dion JE, Gates PC, Fox AJ, Barnett HJ, Blom RJ. Clinical events following neuroangiography: a prospective study. Stroke 1987; 18:997-1004. Crossref, MedlineGoogle Scholar
  • 9 Earnest F, Forbes G, Sandok BA, et al. Complications of cerebral angiography: prospective assessment of risk. AJR Am J Roentgenol 1984; 142:247-253. Crossref, MedlineGoogle Scholar
  • 10 Eisenberg RL, Bank WO, Hedgcock MW. Neurologic complications of angiography in patients with critical stenosis of the carotid artery. Neurology 1980; 30:892-895. Crossref, MedlineGoogle Scholar
  • 11 Faught E, Trader SD, Hanna GR. Cerebral complications of angiography for transient ischemia and stroke: prediction of risk. Neurology 1979; 29:4-15. Crossref, MedlineGoogle Scholar
  • 12 Heiserman JE, Dean BL, Hodak JA, et al. Neurologic complications of cerebral angiography. AJNR Am J Neuroradiol 1994; 15:1401-1407. MedlineGoogle Scholar
  • 13 Komiyama M, Yamanaka K, Nishikawa M, Izumi T. Prospective analysis of complications of catheter cerebral angiography in the digital subtraction angiography and magnetic resonance era. Neurol Med Chir (Tokyo) 1998; 38:534-539. Crossref, MedlineGoogle Scholar
  • 14 Leffers AM, Wagner A. Neurologic complications of cerebral angiography: a retrospective study of complication rate and patient risk factors. Acta Radiol 2000; 41:204-210. Crossref, MedlineGoogle Scholar
  • 15 Mani RL, Eisenberg RL, McDonald EJ, Jr, Pollock JA, Mani JR. Complications of catheter cerebral arteriography: analysis of 5,000 procedures. I. Criteria and incidence. AJR Am J Roentgenol 1978; 131:861-865. Crossref, MedlineGoogle Scholar
  • 16 McIvor J, Steiner TJ, Perkin GD, Greenhalgh RM, Rose FC. Neurological morbidity of arch and carotid arteriography in cerebrovascular disease: the influence of contrast medium and radiologist. Br J Radiol 1987; 60:117-122. Crossref, MedlineGoogle Scholar
  • 17 Olivecrona H. Complications of cerebral angiography. Neuroradiology 1977; 14:175-181. Crossref, MedlineGoogle Scholar
  • 18 Takahashi M, Kawanami H. Complications of catheter cerebral angiography: an analysis of 500 examinations. Acta Radiol Diagn (Stockh) 1972; 13:248-258. Crossref, MedlineGoogle Scholar
  • 19 Aspelin P. Effect of ionic and non-ionic contrast media on morphology of human erythrocytes. Acta Radiol Diagn (Stockh) 1978; 19:675-687. Crossref, MedlineGoogle Scholar
  • 20 Aspelin P. Effect of ionic and non-ionic contrast media on whole blood viscosity, plasma viscosity and hematocrit in vitro. Acta Radiol Diagn (Stockh) 1978; 19:977-989. Crossref, MedlineGoogle Scholar
  • 21 Gawel M, Burkett M, Rose FC. Platelet activation following cerebral angiography. Acta Neurol Scand 1980; 61:240-243. MedlineGoogle Scholar
  • 22 Laerum F. Injurious effects of contrast media on human vascular endothelium. Invest Radiol 1985; 20:S98-S99. Crossref, MedlineGoogle Scholar
  • 23 Popadic A, Witzmann A, Amann T, et al. The value of intraoperative angiography in surgery of intracranial aneurysms: a prospective study in 126 patients. Neuroradiology 2001; 43:466-471. Crossref, MedlineGoogle Scholar
  • 24 Vitaz TW, Gaskill-Shipley M, Tomsick T, Tew JM, Jr. Utility, safety, and accuracy of intraoperative angiography in the surgical treatment of aneurysms and arteriovenous malformations. AJNR Am J Neuroradiol 1999; 20:1457-1461. MedlineGoogle Scholar
  • 25 Derdeyn CP, Moran CJ, Cross DT, Grubb RL, Jr, Dacey RG, Jr. Intraoperative digital subtraction angiography: a review of 112 consecutive examinations. AJNR Am J Neuroradiol 1995; 16:307-318. MedlineGoogle Scholar
  • 26 Leow K, Murie JA. Cerebral angiography for cerebrovascular disease: the risks. Br J Surg 1988; 75:428-430. Crossref, MedlineGoogle Scholar
  • 27 Theodotou BC, Whaley R, Mahaley MS. Complications following transfemoral cerebral angiography for cerebral ischemia: report of 159 angiograms and correlation with surgical risk. Surg Neurol 1987; 28:90-92. Crossref, MedlineGoogle Scholar
  • 28 Cloft HJ, Joseph GJ, Dion JE. Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation: a meta-analysis. Stroke 1999; 30:317-320. Crossref, MedlineGoogle Scholar
  • 29 Skalpe IO. Complications in cerebral angiography with iohexol (Omnipaque) and meglumine metrizoate (Isopaque cerebral). Neuroradiology 1988; 30:69-72. Crossref, MedlineGoogle Scholar
  • 30 Wishart DL. Complications in vertebral angiography as compared to non-vertebral cerebral angiography in 447 studies. Am J Roentgenol Radium Ther Nucl Med 1971; 113:527-537. Crossref, MedlineGoogle Scholar
  • 31 Antonovic R, Rosch J, Dotter CT. The value of systemic arterial heparinization in transfemoral angiography: a prospective study. Am J Roentgenol 1976; 127:223-225. Crossref, MedlineGoogle Scholar
  • 32 Davies KN, Humphrey PR. Complications of cerebral angiography in patients with symptomatic carotid territory ischaemia screened by carotid ultrasound. J Neurol Neurosurg Psychiatry 1993; 56:967-972. Crossref, MedlineGoogle Scholar

Article History

Published in print: May 2003