Assessment of Complication Types and Rates Related to Diagnostic Angiography and Interventional Neuroradiologic Procedures

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Abstract
We determined the types and rates of complications related to diagnostic angiography and neuroradiologic interventional procedures at a centre that carries out the full spectrum of angiographic procedures. The occurrence of immediate and delayed complications in 1929 neuroangiographic procedures (1358 diagnostic and 571 interventional) performed between the years 1993–1996 was prospectively identified and recorded on a daily basis. A retrospective review of all charts of patients having procedures conducted during the study period was also carried out to ensure that no complications were missed. The overall complication rate for diagnostic cerebral angiography was 2.2%. Puncture site complications ranged from 0 – 0.1%. Vessel injury distal to the puncture site ranged from 0.2 – 0.6%. The temporary neurologic complication rate was 0.3%, while the permanent rate was 0.4%. There were no contrast reactions. The death rate was 0.1%. Interventional procedures had higher incidences of complications with overall rates ranging from 5.3 – 33%. Temporary and permanent neurologic deficits occurred at a rate of 0 – 10.5% depending upon the procedure involved. Individual complication and death rates and complication categories are provided for arteriovenous malformation embolisation, tumour embolisation, temporary balloon occlusion tests, detachable balloon vessel sacrifice, urokinase infusion, angioplasty, papavarine infusion, GDC embolisation, and carotid cavernous fistula embolisation. When carried out in experienced hands, neuroangiography and neurointervention are relatively safe with low incidences of neurologic and non-neurologic complications. Knowledge of these rates is important when counselling patients prior to treatments or deciding upon the risk-benefit ratio of preoperative procedures.