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Complication rates of diagnostic cerebral arteriography in children
Eva Fung1, Vijeya Ganesan, Timothy S C Cox
1Neurology Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK. eva1809@hotmail.com
Insights
Cerebral arteriography (CA) is a valuable tool for diagnosing pediatric cerebrovascular conditions. This study found that while local complications occur in about 5% of pediatric CA procedures, serious neurological complications are rare.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Vascular Imaging
Background:
- Cerebral arteriography (CA) is the gold standard for visualizing intra- and extracranial vascular anatomy.
- Existing safety data for CA primarily comes from adult studies, which may not reflect pediatric-specific risks.
Purpose of the Study:
- To assess the rates of local and neurological complications associated with pediatric CA.
- To evaluate the safety of CA in a UK tertiary children's hospital setting.
Main Methods:
- Retrospective review of 176 CA procedures in 150 pediatric patients (neonate to 19 years) from January 1998 to July 2003.
- Data collected included patient demographics, diagnoses, referral sources, and complication types.
- Complications were categorized as local (e.g., hematoma, bleeding) or neurological.
Main Results:
- No neurological complications or deaths were reported in the study cohort.
- Local complications occurred in 8 children (4.5%), including groin hematomas and bleeding at the puncture site.
- One child experienced a transiently reduced pedal pulse, which resolved without intervention.
Conclusions:
- Cerebral arteriography remains a crucial diagnostic tool for pediatric cerebrovascular diseases.
- Neurological complications from pediatric CA are infrequent.
- Local complications are relatively common (approximately 5%) but generally minor and manageable.
Background:
Cerebral arteriography (CA) remains the gold standard in delineating both intra- and extracranial vascular anatomy. Most data relating to the safety of CA are drawn from studies of adult patients in whom the practicalities of the procedure, range of potential pathologies and comorbid factors are different from those in children.
Objective:
To evaluate the current local and neurological complication rates of paediatric CA in the setting of a tertiary level children's hospital in the UK.
Materials And Methods:
Data from patients who had undergone CA between January 1998 and July 2003 were reviewed. The medical, anaesthetic and nursing records, and angiography reports were reviewed for all identified patients. The following parameters were extracted and entered into a proforma: gender, age, ethnicity, diagnosis, cerebrovascular diagnosis, referral source, date of CA, number of vessels catheterized and local and neurological complications.
Results:
A total of 176 CA studies were undertaken in 150 patients (median age 7.3 years, range neonate to 19 years; 83 males, 67 females) during the 5.5-year study period. The majority of referrals originated from the neurology (58%) and neurosurgery services (27.8%). No neurological complications or deaths occurred. Local complications occurred in eight children (4.5%). Five children had a groin haematoma and two had bleeding at the puncture site. A single child had a reduced pedal pulse distal to the site of catheterization, but Doppler imaging was normal.
Conclusions:
CA has a continuing role in the evaluation of cerebrovascular pathologies in children. Neurological complications are rare and local complications are not uncommon (around 5%), but are not usually serious.