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(Stroke. 2006;37:2535.)
© 2006 American Heart Association, Inc.

Original Contributions

Safety of Cerebral Digital Subtraction Angiography in Children

Complication Rate Analysis in 241 Consecutive Diagnostic Angiograms

Ingrid M. Burger, BS; Kieran J. Murphy, MD; Lori C. Jordan, MD; Rafael J. Tamargo, MD Philippe Gailloud, MD

From the Division of Interventional Neuroradiology (I.M.B., K.J.M., P.G.), the Department of Bioethics (I.M.B.), the Division of Pediatric Neurology (L.C.J.), and the Division of Cerebrovascular Neurosurgery (R.T.), Johns Hopkins University, Baltimore, Md.

Correspondence to Philippe Gailloud, MD, Division of Interventional Neuroradiology, Johns Hopkins School of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287. E-mail phg{at}jhmi.edu

Background and Purpose— Catheter-based cerebral angiography remains an important diagnostic tool in the pediatric population, particularly considering the currently growing interest in diagnosing and treating cerebrovascular disorders in children. There are no recent estimates of the complication rate associated with modern diagnostic digital subtraction angiography (DSA) in the pediatric population. The purpose of this study was to estimate the rate of complications occurring during cerebral angiography in children.

Methods— Data from 241 consecutive pediatric cerebral angiograms performed at a single institution were entered into an institutional review board–approved database. Information on patient demographics, DSA indication, neurovascular diagnosis, and intra procedural and postprocedural complications was collected.

Results— Our population included 115 boys and 90 girls, with age ranging from 1 week to 18 years (mean±SD, 12±5 years). All angiograms were technically successful. No intraprocedural complication was noted; in particular, there was no occurrence of iatrogenic vessel injury (dissection) and no transient or permanent neurological deficit secondary to a thromboembolic event. One child with a complex dural arteriovenous fistula experienced a fatal intracranial rehemorrhage secondary to a posterior fossa varix rupture 3 hours after completion of an uneventful diagnostic angiogram. The rates of intraprocedural and postprocedural complications were therefore 0.0% (95% CI, 0.0% to 1.4%) and 0.4% (95% CI, 0.012% to 2.29%), respectively.

Conclusions— The rate of immediate complications occurring during diagnostic cerebral angiography in children is very low. No intraprocedural complication was documented in the reported series. DSA performed by experienced angiographers is a safe procedure that can provide critical diagnostic information.

Key Words: catheter-based angiography • children • complications