Current utility of diagnostic catheter cerebral angiography

The role of diagnostic catheter cerebral angiography has been recently thought to have diminished with the increasing use of noninvasive modalities such as computed tomography angiography and magnetic resonance angiography. Because it is invasive and costly, we sought to elucidate the clinical utility of catheter angiography by evaluating the indications, incidence of new and clinically meaningful findings, and its utility compared with noninvasive studies.

We performed an observational cross-sectional study of consecutive patients undergoing diagnostic cerebral angiography at an urban tertiary care center. We prospectively recorded procedural indications, the findings of previously performed noninvasive studies, the actual angiogram findings, and whether these were new. We defined a new finding as any novel and clinically meaningful piece of anatomic brain vascular information.

Of the 200 consecutive studies over 8 months, 55% were for purely diagnostic purposes, whereas the remaining were for surveillance. The most common indications were subarachnoid hemorrhage, ischemic stroke, intracerebral hemorrhage, cerebral aneurysm, and arteriovenous malformation. New findings were detected in 43% of purely diagnostic angiograms and 32% of surveillance studies. We found false-negative rates of 9.9% and false-positive rates of 11.7%. In 23.4% of cases, more precise anatomic information was found that was subjectively deemed clinically meaningful.

Our snapshot of 200 consecutive catheter cerebral angiograms shows that it is used for both primary diagnosis and surveillance in a wide variety of indications. Despite recent imaging trends, diagnostic catheter angiography provides clinically meaningful diagnostic information in enough cases to warrant continued use.