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[Clinically silent cerebral embolisms after cerebral catheter angiography]
1Abt. Neuroradiologie, Universitätsklinikum Heidelberg. Stefan_Haehnel@med.uni-heidelberg.de
Purpose:
To assess for the incidence of clinically silent cerebral lesions after cerebral catheter angiography.
Methods:
MRI including PD-, T2-, and diffusion-weighted images was performed shortly before and after 27 cerebral catheter angiographies.
Results:
After 5/27 angiographies (18.5%) we found 6 new, presumably embolic cerebral lesions with a typical diameter of 2-3 mm on diffusion-weighted images. No correlation was found between the occurrence of these lesions and a preexisting arteriosclerotic cerebrovascular disease, fluoroscopy time, or number of angiographic series.
Conclusion:
Cerebral angiography appears to be associated with a relatively high risk (about 20%) of clinically silent cerebral embolism. This risk is higher than has been estimated based on the incidence of neurological deficits (0.1-0.3%) after cerebral angiography. The safety of cerebral angiography needs to be improved. Diffusion-weighted MR imaging is suitable to monitor the safety of angiographic procedures and material.
Insights
Cerebral angiography causes clinically silent brain lesions in about 20% of patients, a higher risk than previously thought. Diffusion-weighted MRI can help monitor the safety of this procedure.
Area of Science:
- Neurology
- Radiology
- Vascular Imaging
Background:
- Cerebral catheter angiography is a common diagnostic procedure.
- The incidence of neurological deficits after angiography is low (0.1-0.3%).
- The risk of clinically silent cerebral lesions is not well-established.
Purpose of the Study:
- To determine the incidence of clinically silent cerebral lesions following cerebral catheter angiography.
- To evaluate the utility of diffusion-weighted MRI in detecting these lesions.
Main Methods:
- Twenty-seven patients underwent cerebral catheter angiography.
- Magnetic resonance imaging (MRI), including PD-, T2-, and diffusion-weighted images, was performed before and after the procedure.
- New cerebral lesions were identified on diffusion-weighted images.
Main Results:
- Six new cerebral lesions were detected in 5 out of 27 patients (18.5%) after angiography.
- These lesions were small (2-3 mm diameter) and presumed embolic.
- No correlation was found between lesion occurrence and patient factors (arteriosclerosis) or procedure details (fluoroscopy time, series number).
Conclusions:
- Cerebral angiography carries a significant risk (approx. 20%) of causing clinically silent cerebral embolism.
- This risk is substantially higher than indicated by neurological deficit rates.
- Diffusion-weighted MRI is a valuable tool for assessing the safety of cerebral angiography and related materials.