Elsevier

Pediatric Neurology

Volume 40, Issue 2, February 2009, Pages 98-101
Pediatric Neurology

Original Article
Pediatric Cerebral Angiography: Analysis of Utilization and Findings

https://doi.org/10.1016/j.pediatrneurol.2008.10.006Get rights and content

Pediatric neuroendovascular procedures are being performed with increasing frequency, for various indications. Reported here is the experience of interventionally trained neurologists performing pediatric cerebral diagnostic angiography between August 1, 2005, and April 30, 2008, at a single tertiary institution. Data regarding patient demographics, diagnostic indication and angiographic diagnosis, procedural complications, and procedural specifications were recorded to assess practice patterns and to track procedural morbidity. In all, 42 patients had 46 procedures during the study period. Mean age was 9.97 years (standard deviation S.D. = 5.39; range, 0.3-18 years); 22/42 were male (52%). Known or suspected vascular malformation was the diagnostic indication for 20 patients; of these, 12 had an arteriovenous malformation, 5 had venous abnormalities, and 3 exhibited no angiographic vascular malformations. In 13 total procedures there was no angiographic pathology. General anesthesia was used in 29/46 procedures (63%). A total of 190 cerebral arteries were individually selected, with a mean number of vessels catheterized of 4.1 (S.D. = 1.7) per procedure. No procedural thromboembolic complications, iatrogenic arterial dissection, or neurologic or vascular access site complications occurred. In conclusion, pediatric cerebral angiography seems to be generally safe, although there should be a strong diagnostic indication, given the inherent procedural risk.

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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