Komplikationen bei der intraarteriellen digitalen Subtraktionsangiographie von Carotisstenosen
Die intraarterielle Angiographie in DSA Technik gilt heute immer noch als „Goldstandard“ zur Abklärung von zerebro-vaskulären Gefäßerkrankungen, obwohl die nichtinvasiven Verfahren - und hier insbesondere die Magnetresonanzangiographie (MRA) - zunehmend Eingang in die Klinik finden. Bei komplexen an...
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Table of Contents: The intra- arterial angiography in DSA technique is still today deemed as the gold standard for the non-invasive investigation of the cerebral-vascular angiopathy, although non-invasive methods, especially MR angiography (MRA), are increasingly being introducd into clinics. Intra-arterial angiography is still utilized in complex anatomical situations and for planning therapy for particular situations. However, as with all invasive methods, there exists with DSA the potential for complications. The aim of this retrospective study was to determine exactly the complications of angiography of carotid stenosis in our clinic, and to identify the possible risk markers by means of our periprocedural data. The retrospective study included 91 patients, who from May 2000 to March 2002 underwent 96 internal and/or external cerebral angiographies of high-grade carotid stenoses at the Department of Radiation Diagnostics at the Philips-Universtät Marburgs Medical Center for Radiology. All information relevant to the procedure, especially the indication, implementation (material used), laboratory data such as peculiarities associated with the procedure were documented in an intervention databank (HI-IQ®, The Society of Interventional Radiology). This data was analyzed and the complications categorized as major and minor in accordance with SCVIR criteria. Additionally, the number of neurological complications (defined as neurological developments within 24 hours after the angiography) was recorded. Eighty five of the 91 total patients were interviewed afterwards in order to collect supplemental information regarding undocumented complications. Six patients could not be evaluated over the telephone. The data analysis of the 96 cerebral angiographies showed that 82 of 91 patients were free of complications. The results revealed a rate of 5,2% for minor complications (five cases: two hematomas, three TIA) and 2,1% for major complications (two cases: one cardiac decompensation, one complete stroke). This study showed a rate of 4,2% for neurological complications: 3,1% were transient, and 1% were permanent (complete stroke). All neurological complications surfaced within the first four hours after the investigation had finished. According to the thresholds recommended by the American College Of Radiology, these results were slightly high (2,5% for reversible neurological deficits, 1% for permanent neurological deficits, and 2% for major complications). This higher rate of complications for reversible neurological deficits found in this study in comparison to other studies can likely be attributed to the morbid patient population (exclusively preoperative investigation of carotid stenosis, high patient age, in 67% of the cases symptomatic carotid stenosis). The creatinine values of the patients with minor complication in this study were significantly above the average creatinine values of all patients (1,36 mmol/l versus 1,10 mmol/l, p < 0,05) and thus presents a risk marker. Due to the small number of cases, no major difference was determined for the patients with major complications. Other risk markers were not found. In summary, it can be said that the mortality rate of the intra-arterial DSA before sheduled therapy for the carotid artery is indeed slight, but the indication via invasive imaging of the supra-aortal vessels should still be taken into account.