Search

Transient cortical blindness is reported to occur in 0.3% to 1% of cerebral angiography procedures. It develops within minutes of contrast medium injection and lasts for up to several days. We report a long episode of transient cortical blindness in a 17-year-old boy with cerebellar haemangioblastoma, which started during the preoperative vertebral angiography and lasted for 5 days. CT performed 2 days after the sudden onset of bilateral visual loss showed multiple asymmetrical lesions within the brain parenchyma in the distribution of the posterior cerebral circulation. Even though the patient's vision was completely restored 5 days after angiography, repeat MRI performed 2 months after angiography showed improvement but with residual lesions in the thalami, cerebellum and occipital lobe.

Background: The aim of the study was to assess (i) the rate of contrast-induced nephropathy (CIN), (ii) the amount and time course of renal dysfunction, (iii) the identification of risk factors and calculation of a risk score for CIN in acute stroke patients after CT perfusion (CTP) and CT angiography (CTA)., Methods: 162 patients were investigated,who had received 140 ml of non-ionic low osmolar contrast agent (300 mg iodine per ml, Ultravist 300, Schering AG) for CTA and CTP. We assessed electrolytes, creatinine, and creatinine clearance before and up to 7 days after administration of contrast agent. In addition, the risk factors for CIN were recorded and a previously validated risk score for CIN was calculated. We also assessed the amount of crystalloid fluid substitution and newly prescribed drugs. CIN was defined as an increase of the serum creatinine-level of > 0.5 mg/dl or > 25% above baseline within 48 hours after contrast agent administration., Results: 154 patients (94 %) received crystalloid fluid substitution (mean 6.1 l) within 48 h after contrast agent administration. During follow-up the creatinine values and the creatinine clearance remained stable while sodium and potassium increased significantly (p < 0.0001) after contrast agent administration. In patients with a pathological creatinine value on admission (n = 40), the creatinine clearance did not decrease significantly (p = 0.18). The risk score for developing a CIN was low in the majority of stroke patients. A manifest CIN occurred in 3 patients (2 %). No patient had to be hemodialysed., Conclusion: CIN is a rare complication in acute stroke patients examined by multimodal contrast-based CT due to the low prevalence of risk factors associated with CIN. In conjunction with appropriate fluid substitution, low osmolar nonionic contrast agents seem to be safe in clinical routine.

Introduction: Cerebral angiography is an invasive procedure associated with a small, but definite risk of neurological morbidity. In this study we sought to establish the nature and rate of complications at our institution among a large prospective cohort of consecutive patients. Also, the data were analysed in an attempt to identify risk factors for complications associated with catheter angiography., Methods: Data were prospectively collected for a consecutive cohort of patients undergoing diagnostic cerebral angiography between January 2001 and May 2006. A total of 2,924 diagnostic cerebral angiography procedures were performed during this period. The following data were recorded for each procedure: date of procedure, patient age and sex, clinical indication, referring specialty, referral status (routine/emergency), operator, angiographic findings, and the nature of any clinical complication or asymptomatic adverse event (arterial dissection)., Results: Clinical complications occurred in 23 (0.79%) of the angiographic procedures: 12 (0.41%) significant puncture-site haematomas, 10 (0.34%) transient neurological events, and 1 nonfatal reaction to contrast agent. There were no permanent neurological complications. Asymptomatic technical complications occurred in 13 (0.44%) of the angiographic procedures: 3 groin dissections and 10 dissections of the cervical vessels. No patient with a neck dissection suffered an immediate or delayed stroke. Emergency procedures (P = 0.0004) and angiography procedures performed for intracerebral haemorrhage (P = 0.02) and subarachnoid haemorrhage (P = 0.04) were associated with an increased risk of complications., Conclusion: Neurological complications following cerebral angiography are rare (0.34%), but must be minimized by careful case selection and the prudent use of alternative noninvasive angiographic techniques, particularly in the acute setting. The low complication rate in this series was largely due to the favourable case mix.

Background: The occurrence of headaches during cerebral angiography or endovascular procedures is an ill-defined issue, as limited information is available to define its frequency, risk factors, pathogenesis and implications for future pain management., Purpose: To determine the frequency of headaches during endovascular procedures (HdEVP) and to define their characteristics and risk factors for their occurrence., Methods: Prospective cross-sectional observational study of adult patients undertaking cerebral angiography or endovascular procedures, recording HdEVP clinical features, previous headache history and procedural variables., Results: One hundred and twenty two procedures were evaluated. HdEVP occurred in 13 patients, both in diagnostic and therapeutic procedures. Pain was described as brief, stabbing or localized pressure of mild to moderate intensity, felt ipsilaterally to the manipulated vessel. Its occurrence was associated with therapeutic interventions (p = 0.007), female gender (p = 0.015) and previous history of more than 4 headache episodes per month (p = 0.018)., Conclusion: HdEVP is an uncommon brief headache that should be further evaluated in the future. Its pathogenesis is probably related to mechanical vessel distension, which activates the trigeminovascular nociceptive system in susceptible individuals.

Introduction: The aim of the present investigation was to elucidate in a large consecutive patient cohort whether the level of training has an effect on the number of microemboli detected by diffusion-weighted imaging (DWI) and which additional risk factors can be identified., Methods: A total of 107 consecutive patients in whom a diagnostic cerebral angiography had been performed were prospectively investigated with DWI; 51 angiographies were performed by experienced neuroradiologists, 56 by neuroradiologists in training., Results: In 12 patients (11.1%), a total of 17 new lesions without any clinically overt neurological symptoms were identified. Of these, 12 patients, 11 (91.7%) with 16 lesions were investigated by junior neuroradiologists. In 11 of 12 patients with DWI abnormalities (91.7%), risk factors could be identified (atherosclerotic vessel wall disease, vasculitis, hypercoagulable states). Experienced neuroradiologists performed 21 of 48 angiographies (43.8%) on patients with the above-mentioned risk factors, whereas junior neuroradiologists performed 27 angiographies in this subgroup (46.2%). The rate of diffusion abnormalities in patients with risk factors was 11/48 (22.9%) - considerably higher than in patients without risk factors (1/59; 1.7%)., Conclusion: The level of experience and the nature of the underlying disease are predictors of the occurrence of cerebral ischemic events following neuroangiography. Alternative diagnostic modalities should be employed in patients who are investigated for diseases with the highest risk of angiographic complications (i.e., vasculitis, and arteriosclerotic vessel wall disease). If diagnostic angiography remains necessary in these patients, the highest level of practitioner training is necessary to ensure good patient outcome.

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.

With a ruptured intracranial aneurysm producing subarachnoid haemorrhage (SAH) cerebral angiography is currently used for identification of the affected vessel. Aneurysm rerupturing is one of the more serious complications of cerebral angiography and has been frequently described. We report a 61-year-old man who presented with SAH who had rerupture of a large aneurysm of the internal carotid artery during angiography. A substantial amount of contrast medium escaped via a ventricular drain. The three main risk factors for rerupture of an aneurysm are: angiography performed within 6 h of the primary SAH, an aneurysm on the internal carotid artery and an unfavourable Glasgow coma score.

We examined the incidence of ischemic lesions occurring after cerebral angiography by means of diffusion weighted MR imaging (DWI). Fifty patients were included in this study. Balloon occlusion tests of the internal carotid artery were performed in 9 of the 50 patients. DWI was performed on the same day as the cerebral angiography or on the following day. No new neurological deficits were found after cerebral angiography. However, 13 of the 50 cases revealed new ischemic lesions after cerebral angiography. The incidence of ischemic lesions was significantly different between patients who underwent balloon occlusion tests and patients who did not. The incidence of ischemic lesions was not influenced by the duration of the procedure, use of additional catheters, total amount of contrast material or the type of contrast material. The incidence of clinically silent ischemic lesions related to cerebral angiography is greater than the incidence of neurological complications. In patients who underwent occlusion tests of the internal carotid artery, the incidence of silent lesions was significantly higher than in patients who did not.

We studied the influence of music on stress reaction of patients during cerebral angiography. We randomised 30 patients to a music or a control group. We measured stress hormones, blood pressure, heart rate and psychological parameters. Patients examined without music showed rising levels of cortisol in plasma, indicating high stress levels, while cortisol in patients examined with music remained stable. Systolic blood pressure was significantly lower listening to music. Patients with a high level of fear did appear to benefit particularly from the music.

We report here a 54-year-old man with an aneurysm arising on a cervical anterior radiculomedullary artery. The aneurysm ruptured just after vertebral angiography for a vascular anomaly of the brain, and it appeared to be fusiform, with thrombosis following angiography. Considering the sequential radiological studies and clinical course, it was assumed to be a dissecting aneurysm caused by the angiography. MRI showed severe swelling of the cervical spinal cord and an infarct in the territory of the anterior spinal artery. The mechanism of this rare complication is discussed.

We report a case of cerebral air embolism resulting from accidental air infection during cerebral angiography. A 60-year-old man was accidentally injected with air via the left subclavian artery. Angiography demonstrated air within the basilar artery. The patient showed signs of posterior circulation ischaemia (confusion, blindness, gaze palsy and hemiparesis). However, MRI, including diffusion-weighted imaging, showed no abnormality 4 h later. The patient was treated with hyperbaric oxygen within 5 h of the embolism. All symptoms and signs resolved completely within a week.

Purpose. To determine the incidence of neurologic complications of cerebral angiography in children with moyamoya syndrome (MMS) as compared to children without MMS. Materials and methods. One-hundred-ninety consecutive cerebral angiograms obtained in 152 children were evaluated. Sixty of these angiograms were obtained in 40 children with MMS. Patients underwent neurologic evaluation prior to and after the procedure. For this study, a neurologic complication was defined as any new focal neurologic deficit or alteration in mental status occurring during the procedure or within the ensuing 24 hours. Results. There were 2 neurologic complications within 24 hours of angiography, one in the MMS group and one in the non-MMS group. One patient with MMS became mute following angiography. The symptom resolved within 12 hours. One patient without MMS being examined postoperatively for residual arteriovenous malformation developed intracranial hemorrhage requiring reexploration 12 hours after the angiogram. Using a two-tail Fisher's exact test, there was no significant statistical difference in the ischemic (P = 0.3) or hemorrhagic (P = 1.0) complication rates between the group of patients with MMS and the non-MMS groups. Conclusion. The risk of a neurologic complication from cerebral angiography in children with MMS is low and not statistically different from the risk in children with other cerebrovascular disorders.

We report the first case of MRI-documented cervical spinal cord injury during cerebral angiography. A 54-year-old woman underwent an angiogram for subarachnoid hemorrhage. Her head was secured in a plastic head-holder. At the end of the procedure, she was found to have a left hemiparesis. MRI revealed high signal in the cervical spinal cord. The etiology may have been mechanical due to patient positioning, or toxic, from contrast medium injection in the vessels feeding the spinal cord, or a combination of both.

We present a patient who developed a painful third nerve galsy two days after angiography had demonstrated a large aneurysm on the P1 segment of the left posterior cerebral artery. CT at this stage demonstrated extensive thrombus within the previously uncomplicated aneurysm. The haemodynamics of this aneurysm resulted in incomplete clearance of contrast medium from its fundus and we posit that this may have promoted thrombus formation. Six months later the aneurysm was shown angiographically to be completely occluded.

In 1095 patients 2770 brain supplying arteries have been studied by i.a.-DSA. Definitive neurological deficits occurred in 0.09%, transient deficits were observed in 0.45%. The reduced complication rate in comparison to former studies seems to be a continued effect of technical progress (DSA) and the use of new isoosmotic contrast media. In order to reduce the "training hospital effect" as to complication rate careful supervision of trainees is necessary. The average fluoroscopy time per vessel is proposed as an objective measure of the investigational skill of a neuroradiologist.

Quantitative percutaneous flow velocity measurements are possible in carotid arteries. The results of the direct percutaneous angiography were measured by means of a Doppler directional flow velocity device and registered on a polygraphy. The results indicate an increase in the flow velocity of the injected as well as the non-injected carotid system. This implies that there are no local constrictions of the carotid artery following intervention and, furthermore, it implies a systematic effect of the puncture and injection itself, or of the contrast medium, on the whole cerebral circulation. A diffuse vasodilatation, at least in the cerebral circulation, is postulated. The possible implications are discussed.

The reports of perangiographic rupture of intracranial aneurysm are very few, but the actual incidence is doubtless higher than reported. We could find only 49 cases in the literature, all of which were recognized by extravasation of contrast media. Three of our own cases are documented; in all of them cerebral angiography was carried out soon after subarachnoid hemorrhages. The danger of cerebral angiography in patients with a recently hemorrhaged intracranial aneurysm is stressed.

The complications of cerebral angiography have been carefully recorded in 308 patients referred for cerebral angiography during one year, 1977--1978. The patients were randomly sampled for metrizamide or meglumine metrizoate as contrast medium according to a code list, and the two contrast media were compared using a double blind technique. The frequency of complications was the same for metrizamide and meglumine metrizoate. Metrizamide had the advantage that it caused no discomfort in selective external carotid angiography, while this was a problem with meglumine metrizoate. The study seemed to indicate that factors other than toxicity of the contrast medium are of major importance to explain the complications of cerebral angiography.

The reports of rupture of an aneurysm during carotid angiography are very few but the actual incidence is doubtless higher than recorded. The case presented is documented with the demonstration of a large middle cerebral artery aneurysm with an intratemporal hematoma, and, in sequence, the rupture of the aneurysm during the height of the injection and the subsequent extensive leakage of the contrast medium. The factors which can lead to rupture of an aneurysm during the angiographic procedure are discussed.

Cerebral angiography was performed in 100 patients in order to study the frequency of adverse effects and complications with a new non-ionic contrast medium, iohexol, compared with an ionic medium, meglumine metrizoate. The study was performed as a double blind clinical trial. Iohexol was better tolerated than meglumine metrizoate, since more patients experienced the injections as painful and unpleasant with metrizoate than with iohexol. However, the subjective adverse effects were minor with both contrast media. There was no statistically significant difference in the frequency of more serious side effects. Transient hemiparesis was seen in two patients who prior to the angiography had suffered from numerous similar attacks per day and in one patient in whom a nearly occluded internal carotid artery was occluded during the examination. These complications occurred in the iohexol group, but are more likely to be due to thromboembolism than to contrast medium toxicity.

This paper describes a complication of selective femorocerebral catheterization which was due to iatrogenic embolization of atherosclerotic material originating from the bifurcation of the common carotid artery. After analysis of the catheter maneuvers inherent to the special shape of the type of catheter used (Sidewinder, Cordis Corporation), it is concluded that this complication resulted from incorrect catheter manipulation and an incorrect choice of the dimensions of the preshaped part of the catheter in relation to the diameter of the aortic arch. Two recommendations to avoid this complication are made.

In a patient with stenosis of the left internal carotid artery acute amaurosis of the left eye was observed after carotid arteriography. The macular branches of the central retinal artery and of the cilioretinal artery were obliterated by embolic material. Two further patients with carotid occlusion and stenosis, in whom spontaneous loss of vision occured, are presented. In such cases the diagnosis may be made with comparable accuracy by other methods, such as ophthalmodynamometry or angioscintigraphy, which entail risk to the patient.

The adverse effects of cerebral angiography with metrizamide and meglumine metrizoate were compared in 20 patients for each contrast medium using a double blind technic. Deterioration of the EEG and bradycardial reactions were seen more often with meglumine metrizoate than with metrizamide and these differences were statistically significant. Metrizamide also had a shorter circulation time, less influence on the blood pressure and EMG than meglumine metrizoate, but these differences were not statistically significant. The clinical examinations showed no difference in the minor adverse effects. One patient had transient hemiparesis and dysarthria after angiography with meglumine metrizoate but no serious complications were seen in the others.

Many neuroradiological procedures are available for the elucidation of lesions presenting with clinical evidence of a cerebellopontine angle syndrome. For 10 years we have favoured plain skull rays, sometimes supplemented by gamma encephalography, followed by angiography and have uncommonly needed further information from other contrast studies before operation. The innocuous value of computed tomography (C.T.) made it necessary to consider modification of this routine which had been found to be very satisfactory in routine practice. To obtain precise information on the diagnostic reliability and complications of the method we reviewed a large consecutive series of patients presenting with angle lesions. The radiological signs in such cases have been described many times and are well known, but our findings in a single comprehensive series emphasize the value of the method and are presented in a review. The modifications induced by CT are discussed.

We have analyzed HR changes greater than 20% among 334 patients and 942 cerebral angiographies. A tachycardial effect was seen in 14.9% of patients, while a bradycardial effect was seen in 7.1% including two patients having cardiac standstill (0.5%). These two patients were examined without atropine premedication after subarachnoid hemorrhage. Patients under 19 years of age, unpremedicated with atropine sulfate and suffering from subarachnoid hemorrhage secondary to ruptured aneurysm or arteriovenous malformation showed a significantly high incidence of bradycardia. On the other hand, patients with the neoplastic disease and having an initial sinus bradycardia showed a significantly high incidence of a tachycardial effect.

The complications of cerebral angiography have been recorded in 1509 examinations with metrizoate (Isopaque Cerebral) and in 1000 examinations with iohexol (Omnipaque). The frequency of complications was 2.0 percent for metrizoate and 1.3 percent for iohexol. Permanent sequelae were seen in 4 patients, 3 in the metrizoate and one in the iohexol group. One of these patients died, probably from thromboembolism. Blood coagulation parameters were studied during the angiography in 22 patients and only minor, probably clinically insignificant changes were found, with no difference between the two contrast media.

A case of acute renal failure after cerebral arteriography with iodinated contrast material in a patient with diabetes and azotemic nephropathy is described. A review of the literature concerning acute renal failure after radiographic contrast material is included. The main risk factors reported in the literature appear to be the presence of diabetic nephropathy and the administration of fairly large doses of iodinated contrast material. Azotemic patients should be kept well hydrated and receive doses of less than 50 cc/m2 of body surface area when studied with such materials. Careful monitoring of urinary output and serum creatinine and ready access to dialytic therapy will aid in the detection and subsequent treatment of this problem.

All types of complications, both minor and major, are tabulated and analyzed in 5531 consecutive cerebral angiographies performed on 3730 patients during a period of 5 years.

A case with angiographic extravasation of contrast medium from ruptured vessels in an arteriovenous malformation is reported and a review of the literature presented.

A total of 13 contrast injections of Isopaque Cerebral (meglumine metrizoate) were made into the precerebral arteries or the aortic arch in 6 patients and the bilateral internal carotid artery blood flow monitored continuously using implanted electromagnetic blood flow probes. The most frequent causes of flow changes were found to be due to sudden changes in arterial blood pressure or ventilation which caused a simultaneous and generally identical flow pattern in the two arteries. In 4 patients a slight increase in flow in the artery receiving contrast medium was observed; the increase ranged from 10 to 20% above control level. In one patient the ICA receiving contrast medium showed an initial drop in blood flow to about 85% within 15 sec while the contralateral side showed an increase in flow to about 110%. This sequence was followed by a 6 minute period of slightly increased blood flow on the injection side while the other side showed a slight decrease. A discrepancy in carotid vasomotor response was seen after the injection of 50 ml of contrast medium into the aortic arch with filling of both carotids in the angiogram. Flow changes thought to reflect "arterial spasm" (increased vascular resistance) were observed during attempts to puncture the common carotid artery. The risks connected with this method are discussed. Repeat flow recordings throughout the 24 hours following angiography did not show flow changes attributable to the angiographic investigation.

Two cases of foreign body embolism of the retinal arteries after percutaneous carotid angiography were encountered within a period of 7 months. Both patients were non-arteriosclerotic. Loss of visual function in direct relation to carotid angiography and the observation of a dark foreign body in a retinal arteriole indicated exogenous embolism. No or only slight remission occurred. Careful ophthalmoscopy in cases of visual complaints after carotid angiography is advised, and if foreign body embolism is suspected, treatment with vasodilators (e. g. amyl nitrite) should be given a trial.

The EC/IC bypass is being performed more and more, and angiography is essential as part of the postoperative evaluation. This review of 41 patients points out the need for selective external carotid angiography in those cases where intracranial vessels fill spontaneously at the same time as the shunt. However, 8 of 11 cases showed the superficial temporal artery to be larger on the selective external carotid angiogram than in the common carotid study done during the same session. In two cases undergoing staged occlusive procedures as treatment for giant aneurysm, the external carotid artery leading to an EC/IC was occluded as an angiographic complication without neurologic sequelae.