Safety of Diagnostic Cerebral and Spinal Digital Subtraction Angiography in a Developing Country: A Single-Center Experience

Background: Digital subtraction angiography (DSA) remains the gold standard imaging modality for cerebrovascular disorders. In contrast to developed countries, the safety of the procedure is not extensively reported from the developing countries. Herein, we present a retrospective analysis of the basic technique, indications, and outcomes in 286 patients undergoing diagnostic cerebral and spinal angiography in a developing country, Pakistan. Methods: A retrospective review of patient demographics, procedural technique and complication rates of 286 consecutive patients undergoing the diagnostic cerebral/spinal angiography procedure at one institution from May 2013 to December 2015 was performed. Neurological, systemic, or local complications occurring within and after 24 h of the procedure were recorded. Results: Mean age reported for all patients was 49.7 years. Of all the 286 cases, 175 were male (61.2%) and the rest female (111, 38.8%). Cerebral DSA was performed in 279 cases (97.6%), with 7 cases of spinal DSA (2.4%). Subarachnoid hemorrhage was the most common indication for DSA accounting for 88 cases (30.8%), closely followed by stroke (26.6%) and arteriosclerotic vascular disease (23.1%). No intra- or post-procedural neurological complications of any severity were seen in any of the 286 cases. One case of asymptomatic aortic dissection was reported (0.3%) in the entire cohort of patient population. Conclusion: Diagnostic cerebral/spinal digital subtraction angiography was found to be safe in Pakistan, with complication rates at par with and comparable to those reported in the developed world.

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Balloon Valvuloplasty for Congenital Aortic Stenosis: Experience at a Tertiary Center in a Developing Country

Journal of Interventional Cardiology ◽

10.1155/2021/6681693 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Fatme A. Charafeddine ◽

Haytham Bou Houssein ◽

Nadine B. Kibbi ◽

Issam M. El-Rassi ◽

Anas M. Tabbakh ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Developing Country ◽

Aortic Regurgitation ◽

Developed Countries ◽

Left Ventricular ◽

Complication Rates ◽

Congenital Aortic Stenosis ◽

Tertiary Center

Background. Aortic valve stenosis accounts for 3–6% of congenital heart disease. Balloon aortic valvuloplasty (BAV) is the preferred therapeutic intervention in many centers. However, most of the reported data are from developed countries. Materials and Methods. We performed a retrospective single-center study involving consecutive eligible neonates and infants with congenital aortic stenosis admitted for percutaneous BAV between January 2005 and January 2016 to our tertiary center. We evaluated the short- and mid-term outcomes associated with the use of BAV as a treatment for congenital aortic stenosis (CAS) at a tertiary center in a developing country. Similarly, we compared these outcomes to those reported in developed countries. Results. During the study period, a total of thirty patients, newborns (n = 15) and infants/children (n = 15), underwent BAV. Left ventricular systolic dysfunction was present in 56% of the patients. Isolated AS was present in 19 patients (63%). Associated anomalies were present in 11 patients (37%): seven (21%) had coarctation of the aorta, two (6%) had restrictive ventricular septal defects, one had mild Ebstein anomaly, one had Shone’s syndrome, and one had cleft mitral valve. BAV was not associated with perioperative or immediate postoperative mortality. Immediately following the valvuloplasty, a more than mild aortic regurgitation was noted only in two patients (7%). A none-to-mild aortic regurgitation was noted in the remaining 93%. One patient died three months after the procedure. At a mean follow-up of 7 years, twenty patients (69%) had more than mild aortic regurgitation, and four patients (13%) required surgical intervention. Kaplan–Meier freedom from aortic valve reintervention was 97% at 1 year and 87% at 10 years of follow-up. Conclusion. Based on outcomes encountered at a tertiary center in a developing country, BAV is an effective and safe modality associated with low complication rates comparable to those reported in developed countries.

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Digital Subtraction Angiographic Study of Circle of Willis in Indian Population in a Tertiary Super-Specialty Hospital

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v3i2.36774 ◽

2018 ◽

Vol 3 (2) ◽

pp. 99-105

Author(s):

Muhammad Abdul Momen Khan ◽

Shakir Husain ◽

Md Shohidul Islam ◽

Md Amir Hossain

Keyword(s):

Digital Subtraction Angiography ◽

Cerebrovascular Disorders ◽

Clinical Importance ◽

Uttar Pradesh ◽

Anatomical Variations ◽

Circle Of Willis ◽

Anterior Communicating Artery ◽

Digital Subtraction ◽

Anterior Circulation ◽

Cross Sectional

Background: Circle of Willis is an anastomotic polygon at the base of the brain which forms an important collateral network to maintain adequate cerebral perfusion. Changes in the normal morphology of the circle may causes the appearance and severity of symptoms of cerebrovascular disorders, such as aneurysms, infarctions and other vascular anomalies.Objectives: The aim of the present study was to analyses the anatomical variations of the circle of Willis by observing the variations in the cerebral arterial circle and was to clarify the clinical importance of these variations in certain forms of cerebrovascular diseases.Methodology: This cross-sectional study was conducted in the department of Neurointervention of Max Super-speciality Hospital, New Delhi, India and Neo multispeciality Hospital, Noida, Uttar Pradesh (UP), India during July 2016 to December 2016 for a period of six (6) months. Patients who were admitted in the Neurointervention department for digital subtraction angiography (DSA) were included in this study. The circle of Willis was then analyzed with the special reference to the complete or incomplete circle, any asymmetry in the configuration and variations in the size, and number of the component vessels, circle with multiple anomalies and absence, fenestration, duplication or triplication of any of the vessels.Results: Morphology and variations of the circle of Willis were studied in 74 patients undergone digital subtraction angiography (DSA). The normal pattern of circle of Willis was observed in 40(54.06%) cases and the remaining 34(45.94%) cases had one or more variations; however, 24(70.58%) cases had variations in the anterior circulation and 10(29.42%) cases had variations in the posterior circulation. 17(50%) cases had variations on the right side compared to 13(38.24%) variations on the left side. 4(11.76%) cases had variations in the anterior communicating artery. Incomplete circle of Willis were found 12(35.28%) cases. Multiple variations were observed in 11 cases (32.35%) in this study. In 4 cases anterior communicating artery aneurysms were observed.Conclusion: Variation of circle of Willis is common in this study of Indian population.Journal of National Institute of Neurosciences Bangladesh, 2017;3(2): 99-105

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Repeat digital subtraction angiography after a negative baseline assessment in nonperimesencephalic subarachnoid hemorrhage: a pooled data meta-analysis

Journal of Neurosurgery ◽

10.3171/2013.9.jns131337 ◽

2014 ◽

Vol 120 (1) ◽

pp. 99-103 ◽

Cited By ~ 34

Author(s):

Nicolaas A. Bakker ◽

Rob J. M. Groen ◽

Mahrouz Foumani ◽

Maarten Uyttenboogaart ◽

Omid S. Eshghi ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Digital Subtraction Angiography ◽

Diagnostic Yield ◽

Meta Analysis ◽

Neurological Complications ◽

Pooled Analysis ◽

Added Value ◽

Initial Assessment ◽

Digital Subtraction ◽

Meta Analyses

Object A repeat digital subtraction angiography (DSA) study of the cranial vasculature is routinely performed in patients with diffuse nonperimesencephalic subarachnoid hemorrhage (SAH) after negative baseline CT angiography (CTA) and DSA studies. However, DSA carries a low but substantial risk of neurological complications. Therefore, the authors evaluated the added value of repeat DSA in patients with initial angiographically negative diffuse nonperimesencephalic SAH. Methods A systematic review of the contemporary literature was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Studies from January 2000 onward were reviewed since imaging modalities have much improved over the last decade. A pooled analysis was conducted to identify the detection rate of repeat DSA. In addition, the diagnostic yield of repeat DSAs in a prospectively maintained single-center series of 1051 consecutive patients with SAH was added to the analysis. Results An initial search of the literature yielded 179 studies, 8 of which met the selection criteria. Another 45 patients from the authors' institution were included in the study, providing 368 patients eligible for the pooled analysis. In 37 patients (10.0%, 95% CI 7.4%–13.6%) an aneurysm was detected on repeat DSA. The timing of the repeat DSA varied from 1 to 6 weeks after the initial DSA. The use of 3D techniques was poorly described among these studies, and no direct comparisons between CTA and DSA were made. Conclusions Repeat DSA is still warranted in patients with a diffuse nonperimesencephalic SAH and negative initial assessment. However, the exact timing of the repeat DSA is subject to debate.

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Safety of diagnostic spinal angiography in children

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-015906 ◽

2020 ◽

pp. neurintsurg-2020-015906 ◽

Cited By ~ 1

Author(s):

Ayushi Gautam ◽

Mina Motaghi ◽

Philippe Gailloud

Keyword(s):

Radiation Exposure ◽

Imaging Modality ◽

Neurological Complication ◽

Neurological Complications ◽

Diagnostic Group ◽

Spinal Angiography ◽

Air Kerma ◽

Contrast Volume ◽

The Difference ◽

Lower Contrast

BackgroundSpinal angiography (SA) is associated with low complications in adults but its safety in children has not been properly analyzed. The goal of our study is to assess the safety of pediatric SA.MethodsThis study is the retrospective analysis of a series of 36 consecutive SA procedures performed in 27 children over a 5-year period. Parameters including neurological complications, non-neurological complications requiring additional management, contrast volume, and radiation exposure were analyzed via univariate and bivariate methods.ResultsOur cohort included 24 diagnostic and 12 combined therapeutic cases in children with an average age of 11.1 years. No neurological or non-neurological complication requiring additional management was recorded. The average volume of contrast administered was 1.6 mL/kg in the diagnostic group and 0.9 mL/kg in the combined group. The average air kerma was 186.9mGy for an average of 36.8 exposures in the diagnostic group, and 264.5mGy for an average of 21 exposures in the combined group. Patients in the combined group had lower contrast load (45% lower on average) and higher air kerma (1.6 times higher on average). The difference in air kerma was due to a higher live fluoroscopy-related exposure.ConclusionsThis study reports the largest pediatric SA cohort analyzed to date and the only one including radiation dose and contrast load. It confirms that pediatric SA is a safe imaging modality with low risk of complications, and demonstrates that SA can be performed in children with low radiation exposure and contrast load.

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WITHDRAWN: Correlation Factor Analysis of Infections and Neurological Complications after Interventional Chemoembolization of Liver Cancer by Digital Subtraction Angiography Images

Neuroscience Letters ◽

10.1016/j.neulet.2020.135200 ◽

2020 ◽

pp. 135200

Author(s):

Mengyan Xing ◽

Zhonghua Ma ◽

Hanfang Fu ◽

Fang Jin ◽

Jing Wang ◽

...

Keyword(s):

Factor Analysis ◽

Liver Cancer ◽

Digital Subtraction Angiography ◽

Neurological Complications ◽

Correlation Factor ◽

Digital Subtraction

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Detection of Intravascular Injection During Cervical Transforaminal Epidural Injection: A Comparison of Digital Subtraction Angiography and Real Time Fluoroscopy

January 2018 - Pain Physician ◽

10.36076/ppj.2018.2.e181 ◽

2018 ◽

Vol 1 (21;1) ◽

pp. E181-E186 ◽

Cited By ~ 1

Author(s):

Saeyoung Kim

Keyword(s):

Contrast Medium ◽

Digital Subtraction Angiography ◽

Real Time ◽

Detection Rate ◽

Imaging Modality ◽

Epidural Injection ◽

Digital Subtraction ◽

Intravascular Injection ◽

Nonionic Contrast Medium ◽

Transforaminal Epidural Injection

Background: Transforaminal epidural injection (TFEI) with local anesthetics and steroids are effective in treating spinal radicular pain. However, inadvertent intravascular injection can lead to severe neurologic complications. To reduce complications of intravascular injection, use of imaging modality, such as real-time fluoroscopy (RTF) or digital subtraction angiography (DSA), has been recommended. DSA is an imaging technique that can clearly visualize the blood vessels from surrounding bones or dense soft tissues by subtracting the pre-contrast image from the image after injecting contrast medium. Objective: In this study, we investigated whether there is a difference between RTF and DSA in the detection of intravascular injection during cervical TFEI. Study Design: Clinical study. Setting: Pain clinic in South Korea. Methods: We prospectively examined 137 cervical TFEIs on 128 patients who have a radiating pain from spinal stenosis and herniated nucleus pulposus. The needle position was confirmed using biplanar fluoroscopy and 2 mL of nonionic contrast medium was injected at the rate of 0.5 mL/sec under RTF. Thirty seconds later, 2 mL of nonionic contrast medium was injected at the rate of 0.5 mL/sec under DSA. Intravascular injection was defined as contrast medium spreading throughout the vascular channel during injection of contrast medium under RTF and DSA. This study is registered in the ClinicalTrials.gov (NCT03040648). Results: The detection rate of intravascular injection in RTF was not statistically different compared to that in DSA (30.7 % vs. 34.3%, P > 0.05). Limitations: We injected 2 mL of contrast medium at the rate of 0.5 mL/sec. Further studies about the ideal injection speed and volume of contrast medium for improvement of detection of intravascular injection during TFEI are needed. This study was a single center study. Therefore, multi-center studies are needed to obtain the high level of evidence. Additionally, the procedural pain physician was not blinded to the type of imaging modality, such as RTF and DSA, to detect intravascular injection. To minimize this confirmation bias and provide homogenous procedural conditions for TFEI, the same procedural physician performed all 137 injections. Conclusions: In this study, there is no significant difference in detection rate of intravascular injection between RTF and DSA during cervical TFEI. Key words: Analgesia, bleeding, clinical trials, complications, diagnostic equipment, epidural, radiculopathy, spine

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Use of Microscope-Integrated Near-Infrared Indocyanine Green Videoangiography in the Surgical Treatment of Spinal Dural Arteriovenous Fistulae

Neurosurgery ◽

10.1227/01.neu.0000368108.94233.22 ◽

2010 ◽

Vol 66 (5) ◽

pp. 978-985 ◽

Cited By ~ 55

Author(s):

Ricardo A. Hanel ◽

Peter Nakaji ◽

Robert F. Spetzler

Keyword(s):

Surgical Treatment ◽

Indocyanine Green ◽

Digital Subtraction Angiography ◽

Near Infrared ◽

Type I ◽

Spinal Angiography ◽

Digital Subtraction ◽

Indocyanine Green Videoangiography ◽

Arteriovenous Fistulae ◽

Excitation Light

Abstract OBJECTIVE Identification and complete interruption of fistulae are essential but not always obvious during the surgical treatment of spinal dural arteriovenous fistulae (dAVFs). We examined cases in which we identified and confirmed surgical obliteration of a spinal dAVF with the aid of microscope-integrated near-infrared indocyanine green (ICG) videoangiography. METHODS ICG videoangiography was performed during 6 surgical interventions in which 6 intradural dorsal AVFs (type I) were interrupted. An operating microscope-integrated light source containing infrared excitation light illuminated the operating field and was used to visualize an intravenous bolus of ICG. The locations of fistulae, feeding arteries, and draining veins and documentation of occlusion of the fistulae were compared with findings on preoperative and postoperative digital subtraction angiography. RESULTS ICG videoangiography identified the fistulous point(s), feeding arteries, and draining veins in all 6 cases, as confirmed by immediate postoperative selective spinal angiography. In 1 case, intraoperative ICG ruled out an additional questionable fistula at a contiguous level suspected on the preoperative angiography. CONCLUSION Microscope-based ICG videoangiography is simple and provides real-time information about the precise location of spinal dAVFs. During spinal dAVF surgery, this technique can be useful as an independent form of angiography or as an adjunct to intra or postoperative digital subtraction angiography. Larger series are needed to determine whether use of this modality could reduce the need for immediate postoperative spinal angiography after obliteration of intradural dorsal AVFs.

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