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Cerebral angiographic risk in mild cerebrovascular disease
G J Hankey1, C P Warlow, R J Sellar
1Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom.
Insights
Cerebral angiography for mild ischemic cerebrovascular disease has a 4% risk of neurological complications like TIA or stroke. The mortality rate is very low, but systemic complications can occur, especially with digital subtraction angiography.
Area of Science:
- Neurology
- Radiology
- Vascular Surgery
Background:
- Ischemic cerebrovascular disease poses significant health risks.
- Carotid endarterectomy is a common intervention for eligible patients.
- Cerebral angiography is used to evaluate patients for this procedure.
Purpose of the Study:
- To determine the complication rates of conventional cerebral angiography.
- To assess risks in patients with mild ischemic cerebrovascular disease.
- To inform risk-benefit analysis for carotid endarterectomy.
Main Methods:
- Systematic review of eight prospective and seven retrospective studies.
- Inclusion of studies on intravenous and intra-arterial digital subtraction angiography.
- Analysis of neurological and systemic complication rates.
Main Results:
- Neurological complication rate (TIA or stroke) is approximately 4%.
- Permanent neurological deficit (disabling stroke) rate is about 1%.
- Mortality rate is less than 0.1%; systemic complications are noted.
Conclusions:
- Cerebral angiography carries a low but significant risk of neurological complications.
- Complication rates must be weighed against the benefits of carotid endarterectomy.
- Digital subtraction angiography, especially intravenous, may have specific systemic complication risks.
Abstract:
We review the eight prospective and seven retrospective studies from which it is possible to derive the complication rate of conventional cerebral angiography for patients with mild ischemic cerebrovascular disease who are potential candidates for carotid endarterectomy. Three studies of intravenous and one of intra-arterial digital subtraction angiography are also examined. An overview of the results suggests that the risk of a neurological complication (TIA or stroke) is about 4% and that a permanent neurological deficit (disabling stroke) occurs in about 1%. The mortality rate is very low (less than 0.1%). Systemic complications are not infrequent, particularly with intravenous digital subtraction angiography. The complication rate of cerebral angiography must be considered when evaluating the risks of carotid endarterectomy in patients with ischemic cerebrovascular disease.