Risk Factors of Ischemic Lesions Related to Cerebral Angiography and Neuro-interventional Procedures

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  • SATO Masayuki
    Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
  • NAKAI Yasunobu
    Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
  • TSURUSHIMA Hideo
    Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
  • SHIIGAI Masanari
    Department of Intervention and Radiology, Faculty of Medicine, University of Tsukuba
  • MASUMOTO Tomohiko
    Department of Intervention and Radiology, Faculty of Medicine, University of Tsukuba
  • MATSUMURA Akira
    Department of Neurosurgery, Faculty of Medicine, University of Tsukuba

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Embolic stroke is not a rare complication of cerebral angiography. The risk factors for incidental embolism after cerebral angiography were retrospectively examined using diffusion-weighted magnetic resonance imaging (DWI) in 180 patients who underwent 247 angiography procedures, consisting of 174 diagnostic angiography and 73 interventional procedures, and magnetic resonance imaging including DWI within 72 hours after angiography. The two neuroradiologists in our hospital detected embolism after cerebral angiography as high-intensity lesions (HIL) on DWI. The relationships between HIL on DWI and procedural factors were evaluated. DWI after cerebral angiography revealed HIL related to the procedure in 72 of 247 angiographies. In all procedures, age (p < 0.01), past history of cerebral infarction (p < 0.05), anti-platelet therapy (p < 0.05), neuro-intervention (p < 0.01), and total amount of contrast medium (odds ratio [OR] 2.125, 95% confidence interval [CI] 1.045-4.321) were significantly correlated with HIL. In diagnostic angiography, the performance of the procedure by a resident operator (OR 2.526, 95% CI 1.214-5.254) was significantly correlated with HIL. Age, past history of cerebral infarction, and previous anti-platelet therapy determined the risk of atherosclerotic changes in patients. The neuro-intervention and total amount of contrast medium used could predict the risk of time limitations for angiography. Resident operator is also a risk factor. This study demonstrates the importance of improving the risk of time limitations for angiography and the risk due to operator inexperience. Further training of residents may be needed to reduce the occurrence of embolic complications.<br>

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