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1.
World Neurosurg ; 133: 74-79, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31574334

RESUMO

BACKGROUND: Indocyanine green (ICG) video angiography has been widely used in cerebrovascular surgery. ICG injection is generally safe, with a low incidence of complications. ICG-related anaphylactic reactions during neurosurgery have been rarely reported. We report the cases of 2 patients who had experienced anaphylactic shock in response to intravenous ICG injection (DID Indocyanine Green [Dongindang, Inc., Gyeonggi-do, Republic of Korea]) during intracranial aneurysm (IA) surgery. CASE DESCRIPTION: The first patient, a 69-year-old woman with an unruptured IA, had been undergoing clipping surgery under general anesthesia. Immediately after ICG injection, her blood pressure suddenly decreased from 140/80 mm Hg to 50/30 mm Hg and she developed a skin rash on her abdomen and all extremities. Chest compression was initiated, and her vital signs gradually recovered to their pre-ICG levels within 10 minutes. The second patient was a 58-year-old woman with an unruptured IA who had been undergoing clipping surgery. After ICG injection, her blood pressure had decreased from 130/80 mm Hg to 60/40 mm Hg, and a rash-like skin lesion was observed on her abdomen. After intravenous injection of norepinephrine and dexamethasone, her blood pressure recovered to its pre-ICG level within 30 minutes and remained stable thereafter. The postoperative ICG skin provocation test findings were positive for both patients; however, only 1 patient showed markedly increased serum tryptase levels. CONCLUSION: Despite the rarity of ICG-related anaphylaxis, clinicians should be aware of this unexpected, but potentially life-threatening, drug reaction in patients undergoing cerebrovascular surgery.


Assuntos
Anafilaxia/etiologia , Angiografia Digital/efeitos adversos , Angiografia Cerebral/efeitos adversos , Verde de Indocianina/efeitos adversos , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Idoso , Feminino , Humanos , Pessoa de Meia-Idade
2.
Medicine (Baltimore) ; 98(44): e17785, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689850

RESUMO

INTRODUCTION: Cerebrovascular imaging is the gold standard for diagnosis of intracranial aneurysms. Rupture of intracranial aneurysm is rare in cerebrovascular angiography, especially in unruptured intracranial aneurysm. PATIENT CONCERNS: A 74-year-old woman was admitted to the hospital for sudden onset of left eyelid ptosis for 1 day with no obvious inducement. The patient had a history of hypertension. Physical examination revealed that she had clear consciousness and normal speech, but the left eyelid drooped. The left pupil diameter was 5 mm and light reflex was absent. The left eyeball could not move, and the right eye examinations were normal. The limb muscle strength and muscle tension were normal. DIAGNOSIS: Bilateral internal carotid artery posterior communicating aneurysm, severe stenosis of the origin of left carotid artery, and right oculomotor nerve palsy. INTERVENTIONS: After the hospital, the aneurysm ruptured and hemorrhaged during radiography, and the patient improved after immediate rescue and treatment. On the third day after angiography, the patient's the condition gradually stabilized. Under the general anesthesia, left carotid artery stenosis stent implantation and left posterior communicating artery aneurysm stent assisted coil embolization were performed successfully. On the second day after embolization, the patient's head computed tomography (CT) showed subarachnoid hemorrhage with hydrocephalus. The patient underwent external ventricular drainage. A month later, the patient underwent ventriculoperitoneal shunt. OUTCOMES: Six months later, the patient visited our hospital for a follow-up, and she was clear-headed, aphasia, right limb hemiplegia with muscle strength grade II, left side autonomous activities, and the GOS score was 2 points. Head CT showed the ventricles were normal. CONCLUSIONS: Acute oculomotor palsy may be a risk factor for rupture of ipsilateral unruptured aneurysms, but more basic research and clinical trial evidence of intracranial aneurysms are needed to confirm this.


Assuntos
Aneurisma Roto/etiologia , Lesões das Artérias Carótidas/etiologia , Artéria Carótida Interna/diagnóstico por imagem , Angiografia Cerebral/efeitos adversos , Aneurisma Intracraniano/diagnóstico por imagem , Idoso , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Feminino , Humanos , Aneurisma Intracraniano/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Doenças do Nervo Oculomotor/diagnóstico por imagem , Doenças do Nervo Oculomotor/etiologia
3.
Ann Vasc Surg ; 60: 236-245, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31200041

RESUMO

BACKGROUND: The goal of this study is to evaluate the safety and efficacy of a novel catheter for right radial artery approach cerebral angiography. METHODS: Patients from the Neurology Department of The Second Affiliated Hospital of Guangxi Traditional Chinese Medical University who underwent diagnostic cerebral angiography of either the left vertebral artery dominant type or balanced type were enrolled in this study. RESULTS: A total of 167 patients were treated between February 2016 and December 2017, of whom 44 were excluded based on study exclusion criteria and 123 were enrolled in the present analysis. Bilateral subclavian artery catheterization and bilateral common carotid artery catheterization were conducted successfully in all 123 patients. The success rate of selective catheterization of the left vertebral artery was 87.8% (108/123). The success rate of selective catheterization of the right vertebral artery using the novel catheter was 89.0% (73/82). The average fluoroscopy time was 6.5 ± 3.4 min, the average operation duration was 47 ± 3.7 (range 50-90) min, and the average dosage of contrast agent was 112.3 ± 8.1 mL. One patient exhibited an absence of pulse in the punctual radial artery after the removal of the arterial compression band, but there was no evidence of ischemia of the distal hand. One patient who was undergoing dual anti-platelet drug treatment suffered from bleeding at the puncture point when deflated for 2 hr after operation; this patient was re-pressurized and re-timed. CONCLUSIONS: This novel catheter improved the success rate of selective left vertebral artery catheterization, and allowed for simplification of the relevant surgical steps. The controllability of this novel catheter was satisfactory, and its associated surgical risk was found to be low.


Assuntos
Artéria Carótida Primitiva , Cateterismo Periférico/instrumentação , Angiografia Cerebral/instrumentação , Transtornos Cerebrovasculares/diagnóstico por imagem , Artéria Radial , Artéria Subclávia , Dispositivos de Acesso Vascular , Artéria Vertebral , Idoso , Idoso de 80 Anos ou mais , Artéria Carótida Primitiva/diagnóstico por imagem , Cateterismo Periférico/efeitos adversos , Angiografia Cerebral/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Artéria Radial/diagnóstico por imagem , Fatores de Risco , Artéria Subclávia/diagnóstico por imagem , Artéria Vertebral/diagnóstico por imagem
4.
World Neurosurg ; 127: e94-e100, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30851466

RESUMO

BACKGROUND: Evidence continues to emerge regarding the inverse relationship between high neurointerventional case volume and complication rates, leading several medical/surgical societies to recommend minimum volumes for specific procedures. Recent data suggest few centers are meeting these requirements. We report a single center's neurointerventional complication rates with associated case volumes, along with a review of the literature. METHODS: A retrospective cohort review of all consecutive patients undergoing diagnostic catheter cerebral angiography and/or neurointerventional procedures between January 1, 2013, and March 1, 2018, was undertaken. No diagnostic or interventional procedures were excluded. All major and minor complications were recorded. RESULTS: A total of 1000 procedures (463 diagnostic cerebral angiograms and 537 neurointerventional procedures) were completed. Of the neurointerventional procedures, 216 (40%) were endovascular thrombectomy, 170 (32%) were aneurysmal embolization, and 48 (9%) were carotid stenting. The mean and median age was 60 years. There were 460 women and 540 men. The total number of major complications for diagnostic angiography, endovascular thrombectomy, ruptured aneurysm embolization, unruptured aneurysm embolization, and carotid artery stenting were 4 (0.9%), 4 (1.9%), 10 (11%), 4 (5.4%), and 3 (6.3%), respectively. CONCLUSIONS: We provided a single-center experience of the relationship between neurointerventional procedural case volume and complication rates in the growth phase of our center's establishment. We demonstrated that as our center was being developed, specific procedural staffing measures allowed proficiency maintenance, acquisition of new techniques, and complication avoidance, whereas specific case volumes crossed the suggested thresholds as defined in the literature.


Assuntos
Angiografia Cerebral/efeitos adversos , Embolização Terapêutica/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Trombectomia/efeitos adversos , Idoso , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Canadá/epidemiologia , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Neuroimagem , Estudos Retrospectivos , Stents , Acidente Vascular Cerebral/cirurgia , Centros de Traumatologia/estatística & dados numéricos
5.
J Neurointerv Surg ; 11(1): 80-83, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30026256

RESUMO

We report two serial neuroendovascular cases of hydrophilic polymer embolic complications, and highlight a unique case of a routine diagnostic cerebral angiogram that was complicated by delayed intracranial hemorrhage requiring surgical decompression. Histopathology specimens revealed organized intravascular thrombi with foci of non-polarizable, basophilic foreign material. Shavings from the hydrophilic coatings of a standard diagnostic catheter and guidewire share histologic characteristics with this intravascular foreign material, confirming the diagnosis of hydrophilic polymer emboli. While this phenomenon has been described for complex neurointerventional procedures, it is rare with routine diagnostic cerebral angiography. Along with a detailed literature review, these cases provides further evidence that even basic hydrophilic coated catheters and/or wires may contribute to the etiology of iatrogenic emboli in the neurovasculature with the potential for acute and subacute complications, requiring further investigation.


Assuntos
Cateterismo/efeitos adversos , Cateteres/efeitos adversos , Angiografia Cerebral/efeitos adversos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Polímeros/efeitos adversos , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Feminino , Corpos Estranhos , Humanos , Hemorragias Intracranianas/terapia , Masculino , Polímeros/administração & dosagem
6.
J Neurointerv Surg ; 11(4): 396-399, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30262655

RESUMO

PURPOSE: The Pipeline Embolization Device (PED) is a routine first-line treatment option for intracranial aneurysms (IAs). The Pipeline Flex Embolization Device with Shield Technology (Pipeline Shield) is an updated version of the PED which has been modified to include a surface phosphorylcholine biocompatible polymer. Its early technical success and safety have been reported previously. Here, we assessed the long-term safety and efficacy of the Pipeline Shield for the treatment of IAs. MATERIALS AND METHODS: The Pipeline Flex Embolization Device with Shield Technology (PFLEX) study was a prospective, single-arm, multicenter study for the treatment of unruptured IAs using the Pipeline Shield. The primary endpoint was a major stroke in the territory supplied by the treated artery or neurologic death at 1-year post-procedure. Angiographic outcomes were also assessed by an independent radiology laboratory at 6 months and 1 year. RESULTS: Fifty patients (mean age, 53 years; 82% female) with 50 unruptured IAs were treated. Mean aneurysm diameter was 8.82±6.15 mm. Of the target aneurysms, 38/50 (76%) were small (<10 mm), 11/50 (22%) were large (≥10 and<25 mm), and 1/50 (2%) was giant (≥25 mm). Forty-seven (94%) were located in the internal carotid artery and three (6%) in the vertebral artery. At 1-year post-procedure, no major strokes or neurologic deaths were reported, and complete occlusion was achieved in 27/33 (81.8%). There were no instances of aneurysm recurrence or retreatment. CONCLUSIONS: Our 1-year follow-up concerning angiographic and safety outcomes corroborate previous evidence that the Pipeline Shield is a safe and effective treatment for IAs. TRIAL REGISTRATION NUMBER: NCT02390037.


Assuntos
Angiografia Cerebral/tendências , Embolização Terapêutica/instrumentação , Embolização Terapêutica/tendências , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Adulto , Idoso , Prótese Vascular/efeitos adversos , Prótese Vascular/tendências , Angiografia Cerebral/efeitos adversos , Embolização Terapêutica/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Retratamento/tendências , Fatores de Tempo , Resultado do Tratamento
8.
Ann Vasc Surg ; 56: 62-72, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30500632

RESUMO

BACKGROUND: The aim of this study is to determine, via retrospective study, the effects of vascular morphology and related factors on the success of selective arterial catheterization of the left vertebral artery when approached via right-sided radial artery cerebral angiography. METHODS: Patients who had undergone diagnostic cerebral angiography were enrolled, and their medical history, catheter type, and vessel morphology were analyzed. RESULTS: A total of 205 patients were enrolled in this study from February 2014 to December 2015. After exclusion according to defined criteria, 161 patients were incorporated into the final analysis. Selective catheterization of the bilateral subclavian artery and the bilateral common carotid artery were conducted successfully in all patients, and the success rate of selective catheterization of the left vertebral artery was 82.0%. The success rate of the left vertebral artery catheterization was positively correlated with the angle between the left vertebral artery and the left subclavicular artery (P < 0.001), with 90° serving as a demarcation point, and this was higher in patients without innominate artery distortion (90.2-75.0%), although this finding was not statistically significant. However, the morphology of the aortic artery did not affect the success rate of selective catheterization of the left vertebral artery (P = 0.189), and there was no significant difference (P = 0.231) in the success rate of selective catheterization if the left vertebral artery was predominant (91.0%, 81/89) or balanced (84.7%, 61/72). A total of 0.9% (2/161) of the patients experienced surgery-related complications. Both these patients exhibited bleeding at the puncture point when they were deflated 2 hr after the operation. They were pressurized and depressurization was again conducted for an appropriate period of time. CONCLUSIONS: The angle between the left vertebral artery and the left subclavicular artery is the primary vessel-associated morphological factor affecting the success rate of selective catheterization of the left vertebral artery in the right-sided radial artery cerebral angiography, while innominate artery distortion also had some more limited impact on this success rate.


Assuntos
Cateterismo Periférico/métodos , Angiografia Cerebral/métodos , Transtornos Cerebrovasculares/diagnóstico por imagem , Artéria Radial/diagnóstico por imagem , Artéria Vertebral , Idoso , Pontos de Referência Anatômicos , Artéria Carótida Primitiva/diagnóstico por imagem , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/instrumentação , Angiografia Cerebral/efeitos adversos , Angiografia Cerebral/instrumentação , Transtornos Cerebrovasculares/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Estudos Retrospectivos , Artéria Subclávia/diagnóstico por imagem , Resultado do Tratamento , Dispositivos de Acesso Vascular , Artéria Vertebral/diagnóstico por imagem
9.
J Stroke Cerebrovasc Dis ; 28(3): 649-654, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30527789

RESUMO

GOAL: Computed tomography angiography (CTA) is a well-tolerated, noninvasive study of the intracranial vascular circulation; however, contrast-induced nephropathy (CIN) has been reported in 5%-7% of patients undergoing CTA. Limited studies have evaluated the risks of CIN in patients undergoing CTA. Our study was designed to evaluate the prevalence and risk factors for CIN in patients with ischemic stroke who receive a CTA. MATERIALS AND METHODS: Single-center, nested, case-control study of patients with ischemic stroke who received a CTA between June 18, 2012 and January 1, 2016. Patients were grouped based on development of CIN. FINDINGS: A total of 209 patients were included in the final analysis (178 controls, 31 cases). The prevalence of CIN during the time period studied was 14.8% (95% confidence interval [CI]: 10.2-20.2). A higher proportion of patients who developed CIN had a history of diabetes mellitus (37 [20.56%] versus 15 [48.39%]; P = .0009) and reported taking no medications prior to admission (35 [19.44%] versus 11 [35.48%]; P = .0458). However, a lower proportion of patients who developed CIN had a history of smoking (59 [32.78] versus 3 [9.68]; P = .0091). After statistical adjustment, only a history of diabetes (odds ratio [OR] 4.15 [95% CI: 1.765, 9.754), taking no medications prior to admission (OR 3.56 [95% CI: 1.417, 8.941]) and a self-reported history of smoking (OR 0.204 [95% CI: 0.057, 0.721]) remained associated with the development of CIN. CONCLUSIONS: Those patients with a history of diabetes mellitus or not taking medications prior to admission should be monitored closely for the development of contrast-induced nephropathy CIN.


Assuntos
Angiografia Cerebral/efeitos adversos , Angiografia por Tomografia Computadorizada/efeitos adversos , Meios de Contraste/efeitos adversos , Nefropatias/induzido quimicamente , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral/métodos , Meios de Contraste/administração & dosagem , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Nefropatias/terapia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prevalência , Terapia de Substituição Renal , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Tennessee/epidemiologia , Fatores de Tempo
10.
J Neurointerv Surg ; 11(2): 166-170, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30194108

RESUMO

BACKGROUND: Little is known about in-stent stenosis (ISS) in patients with aneurysms treated with flow diverter (FD) stents. The reported incidence in the literature varies significantly. OBJECTIVE: The aim of this study was to assess the incidence, severity, distribution, clinical significance, and possible predictors for ISS. METHODS: Between July 2012 and June 2016 we retrospectively reviewed all patients treated with SILK FDs in our center. Only cases with short-term (4±2 months) and long-term (>1 year) follow-ups with digital subtraction angiograms were included. ISS was graded as mild (<25%), moderate (25-50%) or severe (>50%). The following predictors for ISS were assessed: gender, age, the presence of subarachnoid hemorrhage, aneurysm size, location, occlusion status, and post-stenting angioplasty. RESULTS: Thirty-six patients met the inclusion criteria. At mid-term follow-up, ISS was observed in 16/36 patients (44%). Eleven patients (69%) had mild ISS, three (19%) moderate, and two (12%) severe ISS. ISS was diffuse in 11 patients (69%) and focal in five patients (31%). All patients were asymptomatic. Thirteen patients were maintained on dual antiplatelet therapy and three on aspirin alone. At long-term follow-up, complete ISS resolution was seen in 11 patients, improvement in three and worsening in two patients. No de novo ISS occurrence was observed. On univariate analysis there was no significant predictor for ISS. CONCLUSIONS: Transient ISS after FD deployment is a common asymptomatic finding on mid-term angiographic follow-up. Complete resolution or improvement at long-term follow-up is seen in most patients who are maintained on dual antiplatelet therapy.


Assuntos
Angiografia Cerebral/tendências , Oclusão de Enxerto Vascular/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Stents Metálicos Autoexpansíveis/tendências , Adulto , Idoso , Angiografia Digital/efeitos adversos , Angiografia Digital/tendências , Aspirina/administração & dosagem , Angiografia Cerebral/efeitos adversos , Feminino , Seguimentos , Oclusão de Enxerto Vascular/epidemiologia , Humanos , Incidência , Aneurisma Intracraniano/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents Metálicos Autoexpansíveis/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
11.
Headache ; 58(8): 1219-1224, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30113076

RESUMO

BACKGROUND AND OBJECTIVE: No reliable estimates of headaches following catheter-based cerebral angiography are available. We performed an observational cohort study to ascertain the frequency and type of headaches following catheter-based cerebral angiography. MATERIALS AND METHODS: Consecutive patients who underwent cerebral angiography through the transfemoral (or infrequently radial) route were included. Each patient underwent a brief neurological assessment after the procedure and more detailed assessment was performed if any patient reported occurrence of a headache. The headaches were classified as migraine if the diagnostic criteria specified by International Headache Society were met. The headache severity was classified using a visual numeric rating scale and time to reach pain free status for 2 consecutive hours was ascertained. RESULTS: Migraine headaches occurred in 5 (3.1%, 95% confidence interval [CI] 1.0-7.2%) of 158 patients who underwent cerebral angiography. The median severity of migraine headaches was 10/10 and time to resolution of headaches was 120 minutes (range 60-360 minutes). Migraine headaches occurred in 4 (18.1%, 95% CI 5.2-40.3%) of 22 patients with a history of migraine and 4 (23.5%, 95% CI 6.8-50%) of 17 patients with regular migraine headaches (≥1 episodes per month). Headaches occurred in 6 (3.8%, 95% CI 1.8-8.0%) patients who did not meet the criteria for migraine headaches. CONCLUSIONS: We provide occurrence rates of migraine headaches, an under-recognized adverse event, in patients undergoing catheter-based cerebral angiography.


Assuntos
Angiografia Cerebral/efeitos adversos , Angiografia Cerebral/métodos , Cefaleia/epidemiologia , Cefaleia/etiologia , Transtornos de Enxaqueca/epidemiologia , Transtornos de Enxaqueca/etiologia , Adulto , Idoso , Angiografia Cerebral/instrumentação , Estudos de Coortes , Feminino , Cefaleia/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Dor Processual/diagnóstico , Índice de Gravidade de Doença , Fatores de Tempo
12.
Pract Neurol ; 18(5): 393-398, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30021800

RESUMO

Catheter-based angiography is an important but invasive procedure in vascular neurology. It is used mainly for diagnosis and for planning treatment in patients with a suspected underlying vascular abnormality. It is often performed as a semiurgent, planned investigation or linked to an interventional procedure. Cerebral angiography provides high-resolution, three-dimensional, pathoanatomical data about the cerebral vasculature and also allows real-time analysis of blood flow. Contrast injections can be repeated to identify subtleties. A physical intervention may also follow angiography. For these reasons, angiography remains the gold standard for delineating vascular lesions of the brain (and spine). Permanent neurological complications are rare, approximately 1%, but become increasingly common in patients aged over 55 years. The main complications are embolic stroke, groin haematoma and contrast-induced nephropathy. In the new era of thrombectomy, it may transpire that other specialists including neurologists may learn to perform the procedure and to manage its complications.


Assuntos
Angiografia Cerebral/efeitos adversos , Angiografia Cerebral/métodos , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/cirurgia , Trombectomia/métodos , Sistema Nervoso Central/diagnóstico por imagem , Humanos
13.
Neurol India ; 66(4): 1154-1158, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30038108

RESUMO

Aim: This study was conducted to evaluate complications (minor and major) that occurred in patients who underwent modern cerebral angiography. Materials and Methods: A retrospective assessment of 644 consecutive cerebral angiographic cases was undertaken with specific emphasis on complications. Results: The most common complication of diagnostic cerebral angiography was groin hematoma seen in 10 (1.55%) patients. One patient had complications arising from the development of a femoral artery pseudoaneurysm. Neurologic complications occurred in 4 (0.62%) cases. Three (0.47%) cases had transient complications which resolved completely within 24 h. One patient (0.16%) was left with permanent hemiplegia. There were 6 (5%) cases of contrast-induced nephropathy out of the 120 cases in whom subarachnoid hemorrhage had occurred and who possessed complete data of kidney function tests. Five of them were reversible, and one was permanent. One patient (0.16%) died from air emboli. Conclusions: Neurologic complications following cerebral angiography are rare but must be minimized by careful case selection and training. Although the risk is small, complications such as permanent disability or even death cannot be completely obviated.


Assuntos
Angiografia Cerebral/efeitos adversos , Humanos , Estudos Retrospectivos
14.
Neurol India ; 66(3): 652-656, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29766914

RESUMO

We examine the problems arising when training residents/fellows (RFs) initiate the learning of diagnostic cervicocerebral angiography (DCCA) and describe the steps on how to facilitate the learning process while avoiding complications. The risk of permanent neurological deficit as a result of DCCA ranges from 0.3-0.5%. Factors that correlated with complications include the following: the history of cerebral infarction, infusion of a large amount of contrast medium, a prolonged fluoroscopic time (>80 min) and the efficiency of training received. These findings suggest that the neurological morbidity depends largely upon the technique of catheterization of the patient. In order to reduce the complications arising from the lack of training, a personalised mentorship with a careful supervision of trainees is necessary. To ensure a good patient outcome, a decreased procedural time, awareness of complications at every step of the procedure and their avoidance, as well as the provision of good quality images is necessary. A mentorship program with a close supervision of the RFs is also one of the prerequisites for obtaining a good result.


Assuntos
Angiografia Cerebral/efeitos adversos , Educação de Pós-Graduação em Medicina/métodos , Bolsas de Estudo , Humanos , Internato e Residência
15.
Turk Neurosurg ; 28(6): 1009-1012, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28481396

RESUMO

Rebleeding of cerebral aneurysms has been previously reported during diagnostic angiography. However, capturing the exact moment of active rebleeding of a cerebral aneurysm during angiography is extremely rare. Here, a case of a rebleeding middle cerebral artery aneurysm during diagnostic digital subtraction angiography (DSA) was illustrated, accompanied with a video demonstration of the incident which is the only one in the literature. During the acquisition of lateral projection DSA images, active extravasation of the contrast medium was witnessed, indicating rebleeding. Simultaneously, there was a sudden rise in arterial blood pressure and an episode of bradycardia. The procedure was terminated immediately and the patient was transferred to the intensive care unit for extraventricular drainage and stabilization of vital signs. Unfortunately, the patient was lost.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Angiografia Digital/efeitos adversos , Angiografia Cerebral/efeitos adversos , Aneurisma Intracraniano/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Idoso , Angiografia Digital/métodos , Angiografia Cerebral/métodos , Meios de Contraste , Feminino , Humanos , Hemorragia Subaracnóidea/diagnóstico por imagem
17.
J Radiol Case Rep ; 12(7): 1-9, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30651912

RESUMO

Improvements in techniques, contrast agents, and catheter design have significantly decreased angiography-related neurological deficits and complications. This article reports a case involving an angiographic total obliteration arteriovenous malformation (AVM) in a patient with an acute infarction in the artery of Percheron (AOP) distribution following angiography. Furthermore, imaging of an AOP acute infarction in cerebral angiography is presented.


Assuntos
Angiografia Cerebral/efeitos adversos , Artérias Cerebrais/diagnóstico por imagem , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/etiologia , Angiografia Digital , Artérias Cerebrais/anatomia & histologia , Infarto Cerebral/terapia , Diagnóstico Diferencial , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/terapia , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Prognóstico
18.
Stroke ; 48(10): 2753-2759, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28916673

RESUMO

BACKGROUND AND PURPOSE: The incidence of periprocedural brain infarcts varies among cardiovascular procedures. In a systematic review, we compared the ratio of radiographic brain infarcts (RBI) to strokes and transient ischemic attacks across cardiac and vascular procedures. METHODS: We searched MEDLINE and 5 other databases for brain infarcts in aortic valve replacement, coronary artery bypass grafting, cardiac catheterization, and cerebral angiogram through September 2015. We followed the PRISMA (preferred reporting items for systematic reviews and meta-analyses) recommendations. We defined symptomatic rate ratio (RR) as ratio of stroke plus transient ischemic attack rate to RBI rate. RESULTS: Twenty-nine studies involving 2124 subjects met the inclusion criteria. In meta-analysis of aortic valve replacements with 494 people, 69.4% (95% confidence interval (CI), 57.6%-81.4%) had RBIs, whereas 3.6% (95% CI, 2.0%-5.2%) had clinical events (RR, 0.08; 95% CI, 0.05-0.12). Coronary artery bypass grafting among 204 patients had 27.4% (95% CI, 6.0%-48.8%) RBIs and 2.4% (95% CI, 0.3%-4.5%) clinical events (RR, 0.11; 95% CI, 0.05-0.26). Cardiac catheterization among 833 people had 8.0% (95% CI, 4.1%-12.0%) RBIs, and 0.6% (95% CI, 0.1%-1.1%) had clinical events (RR, 0.16; 95% CI, 0.08-0.31). Cerebral angiogram among 593 people had 12.8% (95% CI, 6.6-19.0) RBIs and 0.6% (95% CI, 0%-13%) clinical events (RR, 0.10; 95% CI, 0.04-0.27). The RR of all procedures was 0.10 (95% CI, 0.07-0.13) without differences in the RRs across procedures (P=0.29). CONCLUSIONS: One of 10 people with periprocedural RBIs during cardiac surgeries and invasive vascular diagnostic procedures resulted in strokes or transient ischemic attacks, which may serve as a potential surrogate marker of procedural proficiency and perhaps as a predictor of risk for periprocedural strokes.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Angiografia Cerebral/efeitos adversos , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/etiologia , Encéfalo/diagnóstico por imagem , Estudos de Coortes , Humanos
19.
Interv Neuroradiol ; 23(5): 546-550, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28662600

RESUMO

Objective To analyse the related risk factors for vasovagal reaction associated with cerebral angiography via femoral catheterisation and discuss treatment measures and prevention and control methods. Methods The data of 3107 patients on whom cerebral angiography was performed in two high-volume interventional neuroradiology centres within 8 years were retrospectively analysed. Patients were divided into the vasovagal reaction and non-vasovagal reaction groups according to whether vasovagal reaction developed. The two groups' clinical data were analysed using univariate and multivariate logistic regression analysis to examine vasovagal reaction-related factors. Results Of the 3107 patients included, 127 developed vasovagal reaction (4.09%). Of the 127 patients who developed vasovagal reaction, 123, three and one had vasovagal reaction after sheath removal, during cerebral angiography and upon femoral artery compression device removal, respectively. Differences in age, body mass index, sex ratios, proportions of patients with hypertension, diabetes and hyperlipemia, and adoption rate of femoral artery compression device were not statistically significant between the two groups ( P > 0.05). Compared with the control group, the vasovagal reaction group had a significantly longer preoperative fasting time ( P < 0.05). Multivariate logistic regression analysis revealed preoperative fasting time as the only risk factor for vasovagal reaction that was associated with cerebral angiography ( P < 0.001). Conclusion Excessive fasting time before cerebral angiography is the most important risk factor for vasovagal reaction associated with cerebral angiography.


Assuntos
Bradicardia/etiologia , Cateterismo Periférico/efeitos adversos , Angiografia Cerebral/efeitos adversos , Hipotensão/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Artéria Femoral , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Estudos Retrospectivos , Fatores de Risco
20.
Mayo Clin Proc ; 92(9): 1445-1451, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28735717

RESUMO

Intracranial aneurysms are common and, on a population-based perspective, are a major cause of morbidity and mortality as a result of mass effect or rupture. Cerebral angiography is the primary technique used for the diagnosis of cerebral aneurysms, and the imaging data have additional utility for planning medical, endovascular, or surgical treatments. An extremely rare periprocedural complication of cerebral angiography is rupture of the aneurysm, either as a chance phenomenon or as a result of some physiologic change or mechanical effect. We report on a single awake, alert patient who experienced intraprocedural aneurysm rupture that was recorded in real time during diagnostic cerebral angiography and subsequently proved fatal. Rupture occurred shortly after the completion of contrast material injection into a semi-open vascular bed and appeared to be temporally unrelated to any supranormal change in systemic physiology. No therapeutic endovascular procedure was planned or attempted. From the high-quality sequential, frame-by-frame images, and electronic sedation and anesthesiology records, plus our own real-time observations (G.L., W.L.L.), we were able (for educational purposes) to reconstruct the time course of rupture of the aneurysm, the velocity and pattern of blood escaping the aneurysm and entering the subarachnoid space, and other physiologic and functional correlates (blood pressure changes, alterations in consciousness) that may be critical to our understanding of the mechanism and consequences of aneurysm rupture.


Assuntos
Aneurisma Roto/etiologia , Lesões Encefálicas/etiologia , Angiografia Cerebral/efeitos adversos , Aneurisma Intracraniano/complicações , Hemorragia Subaracnóidea/etiologia , Idoso , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Morte Encefálica , Angiografia Cerebral/métodos , Angiografia Cerebral/normas , Cineangiografia/métodos , Evolução Fatal , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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