Guide to Peripheral and Cerebrovascular Intervention

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A subpopulation of 16 pediatric patients was identified as those younger than 21 years of age 5. The three most common angiographic indications Fig. A subpopulation of patients 81, This included patients with any number of combinations of 2 or more diseases which accounted for their ailment and hence served as indications for the procedure.

Note, right ophthalmic artery subtle irregularity and delayed antegrade flow compared to the normal left ophthalmic artery b. Note left posterior cerebral artery branch fed arteriovenous fistula. Amongst the pediatric population, the most common indication for angiography was intracerebral hemorrhage 6, Out of the 16 pediatric patients, cerebral angiography was performed on 14 Of all the procedures, cerebral angiography was performed in cases A single catheter was used in Retrograde femoral artery approach was used to perform the procedure in Intraprocedural complications were divided into local, systemic, and neurological.

Extracranial vascular disease

No local or systemic complications were seen. One asymptomatic procedural complication 0. No complications were seen in the pediatric population. Also there were no complications in any of the spinal angiography procedures. There were no instances of anaphylaxis to contrast medium, nephrotoxicity secondary to the use of contrast medium, nausea, vomiting, or systemic hemodynamic collapse. This retrospective analysis of DSA at a single center in Pakistan reveals complication rates well within the range as specified in the cooperative statement issued by the Society of Interventional and Therapeutic Neuroradiology and American Academy of Neuroradiology [ 11 ].

According to these guidelines, the allowable complication rate threshold for reversible neurological deficits is The incidence of asymptomatic aortic dissection was reported in 4 cases 0. This single incidence of aortic dissection did not require additional hospital stay or stenting and was completely asymptomatic. The patient, a year-old female, had suffered a prior subarachnoid hemorrhage for which an angiography procedure was performed sometime earlier at another institution. In consideration to this, radial artery access was used to perform the procedure.

It is worth mentioning that this was the only case in the entire cohort in which radial artery approach was used. These results are also comparable to those reported by Johnston et al. This study reported an overall complication rate of 0.

In order to account for the difference in complication rates reported in our study and those by Johnston et al. Another large scale study conducted by Dawkins et al.

Neurology: CVA & TIA

One of the largest studies investigating the safety and complications following cerebral angiography was conducted in by Kaufmann et al. In this study, data for 19, cerebral angiographies from to were retrospectively reviewed and an overall neurological complication rate of 2.

FDA issues advisory on appropriate catheters for neurovascular thrombus removal

Our complication rates, when compared with both large- and small-scale studies, not only corroborate but extend the findings reported in these. Of the 81 patients This goes to show that the use of DSA could potentially be advocated for both symptomatic and asymptomatic patients, with or without comorbidities. In all of the 7 cases where spinal digital subtraction angiography SpDSA was performed, no neurological or nonneurological complications were seen.

Although the number of studies investigating complications in exclusively spinal angiographies is low, rates similar to ours have been reported in those studies [ 16 , 17 ]. The complication rate for SpDSA has drastically declined from 2. A study conducted by Kieffer et al. In , another year retrospective single center study by Chen et al. With the increase in understanding and recognition of cerebrovascular disorders in the pediatric population, there has been a concomitant rise in the number of studies exploring the safety and efficacy of angiography in this population.

These cases have been considered separately in our study due to the unique anatomy and physiology of pediatric cerebral vasculature, increased vessel fragility and smaller caliber, all of which makes these cases more susceptible to complications secondary to catheter-based angiography. In a study conducted by Burger et al. Recently, another study conducted by Ning et al. Similar results were reported by Hoffman et al. These results help encourage the use of DSA safely in all age groups with complication rates similar to those reported in adult populations. Both angiography equipment and operator skills have led to a significant reduction in neurological complications over the recent years.

Use of continuous catheter flush systems employing heparinized saline that is infused via dedicated pumps with air embolism protection systems has further lowered the complication rates.

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In a developing country like Pakistan, conventional cerebral angiography DSA is a cost-effective and safe method for providing detailed information on the cerebrovascular anatomy and adding to patient-specific treatment plan. Protocols for obtaining Ethics Certificate from the respective institutions were fulfilled along with acceptance of full responsibility and compliance to maintaining patient confidentiality.

The authors report that there is no conflict of interest to disclose. The authors do not have any personal, professional or otherwise affiliations with any product mentioned in the text.


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Extracranial vascular disease

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    The only reported use of drug-eluting stents in intracranial vessels was in canine models. CASE REPORT A year-old Caucasian female with hyperlipidemia, hypertension, and a twenty pack-year history of smoking presented seven months earlier with an infarct involving the right parietal lobe. The patient was treated with aspirin and atorvastatin, and advised to quit smoking. However, two weeks following angiography, she had another small right MCA territory stroke. Repeat angiography showed worsening of the MCA stenosis, which had also developed irregular margins.

    Due to the rapid progression of the stenosis and the decreased cerebrovascular reserve, she underwent angioplasty and stenting following pretreatment with clopidogrel for five days. A 5F diagnostic JR4 catheter was advanced into the right external carotid artery over a floppy angled Glidewire using roadmapping guidance. The angled Glidewire was then exchanged for a stiff 6cm tip Amplatz wire, followed by removal of the JR4 catheter.

    An 8F 70cm Rabbe sheath was then advanced into the distal right common carotid artery. A long Synchro 0. Predilatation of the right M1 segment was performed using the Maverick balloon, which resulted in some plaque shift into the origin of the inferior division.


    A second Synchro wire was advanced into the inferior division with the intention of dilating the origin. However, this origin stenosis was alleviated with wire crossing, thus, balloon dilatation was not required. We then proceeded to advance an over-the-wire 2. This was done with moderate difficulty since the Synchro wire is a soft wire, and there was tortuosity in the distal ICA.

    Guide to Peripheral and Cerebrovascular Intervention Guide to Peripheral and Cerebrovascular Intervention
    Guide to Peripheral and Cerebrovascular Intervention Guide to Peripheral and Cerebrovascular Intervention
    Guide to Peripheral and Cerebrovascular Intervention Guide to Peripheral and Cerebrovascular Intervention
    Guide to Peripheral and Cerebrovascular Intervention Guide to Peripheral and Cerebrovascular Intervention
    Guide to Peripheral and Cerebrovascular Intervention Guide to Peripheral and Cerebrovascular Intervention
    Guide to Peripheral and Cerebrovascular Intervention Guide to Peripheral and Cerebrovascular Intervention

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