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Published on: October 20, 2017
Low rate of complications of cerebral angiography in routine clinical practice
D C Johnston1, K M Chapman, L B Goldstein
1Division of Neurology, University of British Columbia and Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada. dccj@interchange.ubc.ca
Insights
Cerebral angiography (ANGIO) has a low neurologic complication rate (0.5% stroke, 0.4% TIA), comparable between academic and community hospitals. This finding is crucial for selecting patients for carotid endarterectomy (CEA).
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Cerebral angiography (ANGIO) is used for carotid endarterectomy (CEA) patient selection.
- Concerns exist regarding ANGIO's complication risks, potentially limiting its use.
- Assessing neurologic complication rates in different settings is vital.
Purpose of the Study:
- To determine the rate of neurologic complications from ANGIO.
- To compare complication rates between an academic medical center (AMC) and a community hospital (CH).
Main Methods:
- Retrospective review of 569 patients undergoing ANGIO.
- Recorded neurologic events (stroke, TIA), myocardial infarction, and death within 24 hours post-procedure.
- Compared AMC and CH complication rates with published data.
Main Results:
- Overall complication rate: 0.5% for stroke, 0.4% for TIA.
- No significant difference in complication rates between AMC and CH.
- One moderate stroke occurred; 4/5 patients with complications proceeded to endarterectomy.
Conclusions:
- Neurologic complications from ANGIO may be less frequent than anticipated.
- ANGIO complication rates are similar in academic and community hospital settings.
- Understanding local ANGIO complication rates aids in CEA patient selection.
Objective:
The use of cerebral angiography (ANGIO) to select patients for carotid endarterectomy (CEA) has been limited by concern about the risk of complications of the procedure. The authors sought to determine the rate of neurologic complications at both an academic medical center (AMC) and a community hospital (CH).
Methods:
The authors reviewed the records of 569 patients undergoing ANGIO. Any documentation of stroke, transient neurologic event, myocardial infarction, or death occurring in the 24 hours after the procedure was recorded. The rate of neurologic complications at the AMC and CH were compared to published studies.
Results:
The overall complication rate was 0.5% for stroke and 0.4% for TIA. There was no difference between the AMC and CH. One of the strokes was of moderate severity and four of the five patients with complications subsequently underwent endarterectomy.
Conclusions:
The rate of major neurologic complications due to ANGIO may be lower than expected, even when performed in a non-academic setting. Awareness of local ANGIO complication rates is important when selecting patients for CEA.
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