Original ArticlePediatric Cerebral Angiography: Analysis of Utilization and Findings
Introduction
A neurologist, Egas Moniz, was responsible for the development of cerebral angiography, when in 1927 he used direct carotid injection of a strontium bromide solution with 2 minutes of proximal ligation; however, the first patient with obtainable angiographic images died 2 hours after the procedure [1]. Since that time, there have been vast technical advances in diagnostic catheters and contrast agents, aimed at improving procedural safety. Because catheter angiography is invasive, patient selection should be aided by a clear diagnostic indication. The incidence and nature of procedure-related morbidity associated with pediatric cerebral angiography is not as well characterized as it is for adult patients [2], [3], [4]. Recent reports on the safety of pediatric cerebral angiography reinforce its role in the clinical management of pediatric cerebrovascular disease, but patterns of usage are not widely described for cerebral angiography in children [2], [3].
Interventional neurology is an emerging subspecialty, one in which a neurologist trained in vascular or critical care performs neuroangiographic procedures, which have traditionally been performed by neuroradiologists and neurosurgeons [5], [6]. Reported here is experience with pediatric cerebral diagnostic angiography encountered as part of an academic interventional neurology practice.
Section snippets
Methods and Procedural Protocol
From August 1, 2005, to April 30, 2008, all diagnostic cerebral angiograms performed at a single academic tertiary referral center with an interventional neurology fellowship program were done by one of two attending interventionalists. First assistants included interventional neurology fellows and residents from the departments of neurology and neurosurgery. Significant portions of some procedures were performed by fellows, under the direct supervision of the attending physician.
For internal
Results
A total of 46 pediatric diagnostic cerebral angiograms were performed on 42 patients during the study period (one patient had 4 diagnostic angiograms, and another had 2). The male/female ratio was 22/20. Of the 42 patients, 27 were European-origin white (64%), of patients, 7 were African American (17%), 5 were Hispanic (12%), and 2 were Asian (3% and 7%). Age ranged from 0.3 to 18 years (mean ± standard deviation: 10.1 ± 5.4). Diagnostic indications and angiographic diagnoses are summarized in
Discussion
This analysis of diagnostic indications for undertaking cerebral angiography and the associated angiographic findings allows insight into its use in clinical practice. With the exception of the seven stroke patients, cerebral angiography was performed only after noninvasive angiography had been completed, using computed tomography or magnetic resonance approaches. If the stroke patients had received noninvasive imaging prior to angiography, several of these urgent angiograms might not have been
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