Interventional Neuroangiography Research Articles

Bacterial Contamination of Syringes and Fluids in Diagnostic and Interventional Neuroangiography.

(1) Background: Bacterial contamination has been shown to occur during angiographies, although data on its frequency and relevance are sparse. Our aim was to evaluate the incidence of bacterial contamination of syringes used under sterile conditions during neuroangiographies. We sought to differentiate between contamination of the outside of the syringes and the inside and to detect the frequency, extent and germ spectrum of bacterial contamination. (2) Methods: We prospectively collected 600 samples from 100 neuroangiographies. Per angiography, fluid samples from the three routinely used syringes as well as the syringes themselves were analyzed. We analyzed the frequency and extent of contamination and determined the germ spectrum. (3) Results: The majority of samples (56.9%) were contaminated. There was no angiography that showed no contamination (0%). The outer surfaces of the syringes were contaminated significantly more frequently and to a higher extent than the inner surfaces. Both the frequency and extent of contamination of the samples increased with longer duration of angiographic procedures. Most of the bacterial species were environmental or skin germs (87.7%). (4) Conclusions: Bacterial contamination is a frequent finding during neuroangiographies, although its clinical significance is believed to be small. Bacterial contamination increases with longer duration of angiographic procedures.

Transradial Approach for Pediatric Diagnostic and Neurointerventional Surgery: Single‐Center Case Series and Systematic Review

BackgroundRecent widespread adoption of a transradial approach in adults has encouraged its use and expansion in children; however, the safety and feasibility of the transradial approach in the latter has not been established. We evaluated these characteristics in our pediatric case series and compared our results with those in the literature.MethodsOur prospectively maintained database was retrospectively searched for consecutive patients ≤18 years of age who underwent diagnostic and interventional neuroangiography through the transradial approach. Patient demographics, indications for the procedure, use of ultrasound guidance, arterial size at the access site, intra‐ and postprocedure complications, and outcomes were recorded. For the literature review, systematic searches of PubMed, MEDLINE, and Embase databases were conducted using keywords with Boolean operators (“radial artery” AND “pediatric”) for studies published in English between January 2000 and September 2021. Continuous variables were reported as means or medians and respective standard deviations and interquartile ranges according to data normality. Categorical variables were reported as frequencies.ResultsTwenty‐one patients were included in our series (mean age, 16.6±2.23 years, range 9–17 years; male sex, 11 [52.4%]). The transradial approach was used for diagnostic angiography in 15 cases (71.4%) and intervention in 6 (28.6%). Ultrasound guidance was used and a “radial cocktail” (verapamil‐heparin‐nitroglycerin) was given in all cases. Mean radial artery access‐site diameter was 2.2±0.46 mm. Two cases (9.5%) required conversion to femoral access. Two patients (9.5%) suffered reversible vasospasm. No radial artery occlusion or permanent neurologic deficits were recorded. The systematic review showed results similar to ours for vasospasm rates (6.3% and 9.5%, respectively) and procedural outcomes (92% and 91%, respectively). [Correction added on November 8, 2022, after first online publication: In the preceding sentence, the value 7% was changed to 6.3%, and the value 93% was changed to 92%.]ConclusionOur results and the literature review demonstrate that the transradial approach is a safe and feasible option for pediatric patients. Routine use of ultrasound guidance, selection of appropriately sized catheters, and prophylactic use of vasodilators and antispasmodics can help ensure the success of the procedure and limit common access‐site complications.

Illustrated Guide to the Transradial Approach for Neuroendovascular Surgery: A Step-by-Step Description Gleaned From Over 500 Cases at an Early Adopter Single Center.

Traditionally, neuroangiography for diagnosis and therapy has been achieved via the transfemoral route. Femoral access, however, has been associated with catastrophic complications. Although transradial access (TRA) has been adopted late by the field of neuroendovascular surgery, several groups have recently demonstrated a dramatically safe and rapid learning curve with a radial-first approach. However, there is a need for a detailed illustrative approach on the transradial technique. To provide a detailed description of the operative technique with step-by-step illustrations derived from our single center series of 506 cases, as an early adopter. A step-by-step illustrated approach to our technique of transradial angiography is provided, based on our clinical experience of an early radial-first approach. Prospective review of patients undergoing transradial angiography and interventions from April 1 to November 30, 2019, at our institution was performed. We included all cases that received radial-first arterial access for diagnostic and interventional neuroangiography. Efficacy, complications, catheter use, and radiation metrics of TRA for the entire cohort were noted. The radial approach was described in 4 stages beginning from the wrist (Stage I) and ending with distal access to target vessel of interest (Stage IV). A total of 506 patients underwent TRA over the 7-mo period. Procedural success was achieved in 92.3% of patients (93.7% for diagnostic and 88.5% for interventional). Crossover to the femoral route occurred in 33 (6.5%) cases (25 diagnostic and 8 interventional). The majority occurred in Stage I. No major complications were noted. Our preferred technique for the transradial approach provides excellent safety and efficacy in performing diagnostic and interventional neuroangiography. The illustrated technical steps are expected to provide guidance for early adopters of TRA.

Nonoperating Room Anesthesia for Interventional Neuroangiographic Procedures: Outcomes of 105 Patients

Background and Aim: Accurate anesthesia management is of great importance for the success of interventional neuroangiographic procedures (INPs). General anesthesia with endotracheal intubation is the most commonly preferred anesthetic method for these procedures. However, whether laryngeal mask airway (LMA) anesthesia is a suitable and safe option for such cases is unclear. The aims of this study were to report the outcomes of anesthetic management in patients who underwent INP, and to compare endotracheal intubation with LMA anesthesia in terms of anesthesia-related outcomes. Methods: Data of patients who underwent INP under general anesthesia at interventional neuroangiography unit were retrospectively evaluated. Results: A total of 105 patients with a mean age of 52.9 years were included in the study. All procedures were performed under general anesthesia with using endotracheal tube (n = 79, 75.2%) or laryngeal mask (n = 26, 24.8%). Anesthesia-related complications, including respiratory (laryngospasm,bronchospasm, and desaturation) and circulatory (disrhythmia, hypotension, hypertension), were observed in 20 (19.1%) patients. The 2 airway instruments were similar in age, gender, diagnosis, American Society of Anesthesiologist score, mallampati score, duration of procedure, and duration of anesthesia (P > .05). Anesthesia-related complications were more common in LMA group compared with patients who were intubated using endotracheal tube (P = .003). Conclusions: Anesthesia management in INPs carries many challenges for anesthesiologists, due to the need of exact immobility during the procedure and potential procedure-related risks such as vasculary perforation and bleeding. General anesthesia using endotracheal intubation seems to be more secure, in comparison to LMA anesthesia.

Neurologists may Perform Interventional Neuroangiography

Neurologists may Perform Interventional Neuroangiography

Interventional neuroradiology in children: diagnostics and therapeutics.

To highlight the spectrum of pediatric neurovascular conditions typically referred for diagnostic or interventional neuroangiography, the range of techniques available in contemporary pediatric neurointerventional practice, and the specific considerations relating to radiation and contrast dosing applicable to pediatric neurointerventional procedures. Neurointerventional procedures are increasingly utilized in children for a variety of indications, with continuous emphasis on improving safety and treatment effectiveness. Numerous steps can be taken to mitigate the potential risks of pediatric neurointerventional procedures, with recent data from high-volume centers suggesting similar, if not lower, complication rates in children compared with adults. Judicious patient selection and clarity of goals are critically important, however, because children undergoing complex and lengthy neurointerventional procedures are particularly vulnerable to the effects of ionizing radiation, vessel injury, and contrast overload. With continued advances in endovascular technology, neurointerventionalists stand to play an important and expanding role in the multidisciplinary management of pediatric neurovascular disease.

Bacterial Contamination During Diagnostic and Interventional Neuroangiography is a Frequent Finding: But Does It Matter? An Observational Study.

Bacterial contamination during angiographic procedures is a potential source of bacteremia. It is largely unknown whether it is clinically relevant. Our aim was to evaluate the incidence of contamination of liquids during catheter-based neuroangiographic examinations, the spectrum of microorganisms, a comparison of two different trolley-settings, and a follow-up of all patients with regard to clinical and lab signs of infection. A total of 170 patients underwent either diagnostic angiography (n = 111) or arterial neuroendovascular procedures (n = 59). To study the impact of airborne contamination of sterile liquids, we randomly assigned equal numbers of procedures to two distinct setups. Group A with standard open-surface bowls and group B with repetitive coverage of liquids throughout the procedure. Patient preparation was performed with utmost care. After each procedure, samples of the liquids were sent for microbiological evaluation. Patients were followed for signs of infection (fever, white blood cell count, C-reactive-protein). Of all samples, 25.3 % were contaminated. Contamination consisted of resident skin microbiota only and was more common with procedures (28.8 %) than with diagnostic angiography (23.4 %) and less common in uncovered (23.5 %) than in covered bowls (27.1 %). However, these differences were insignificant. None of the patients developed clinical or lab signs of infection. Contamination during diagnostic and interventional angiography does occur and cannot be avoided by intermittent coverage. Despite a surprisingly high incidence, our findings support the common strategy that antibiotic coverage is unnecessary in most patients undergoing arterial angiography as it lacks clinical impact. Airborne contamination does not appear to play a role.

Electroneurodiagnostic Monitoring In Interventional Neuroangiography

ABSTRACT.Current trends in neurosurgery suggest there are progressive changes in the way neurovascular abnormalities will be treated (Higashida et al. 2007). Recent technological advancements have been made in the field of Interventional Neuroangiography (IN) which, in some instances, have enabled it to provide better outcomes than surgical treatment. Research is currently being done which promises to increase the effectiveness of IN far beyond that of neurosurgical techniques. How should we, as electroneurodiagnostic technologists, view this change and what does it mean to our field?

Real-time integration of 3-D multimodality data in interventional neuroangiography

We describe a novel approach to using soft-tissue data sets, such as computer tomography on magnetic resonance, in the minimally invasive image guidance of intra-arterial and intravenous endovascular devices in neuroangiography interventions. Minimally invasive x-ray angiography procedures rely on the navigation of en- dovascular devices, such as guide wires and catheters, through hu- man vessels, using C-arm fluoroscopy. Although the bone structure may be visible and the injection of iodine contrast medium allows one to guide endovascular devices through the vasculature, the soft-tissue structures remain invisible in the fluoroscopic images. We intend to present a method for the combined visualization of soft-tissue data, a 3-D rotational angiography (3-DRA) reconstruc- tion, and the live fluoroscopy data stream in a single fused image. Combining the fluoroscopic image with the 3-DRA vessel tree offers the advantage that endovascular devices can be located within the vasculature without additional contrast injection, while the position of the C-arm geometry can be altered freely. The additional visualiza- tion of the soft-tissue data adds contextual information to the posi- tion of endovascular devices. We address the clinical applications, the real-time aspects of the registration algorithms, and fast-fused visualization of the proposed method. © 2009 SPIE and

The safety and efficacy of the Angio-Seal closure device in diagnostic and interventional neuroangiography setting: a single-center experience with 1,443 closures

We evaluated the safety and efficacy of the Angio-Seal closure device used to close arterial puncture sites in patients who had undergone diagnostic cerebral angiography and neurointerventional procedures. A total of 1,443 Angio-Seal devices were placed in 1,099 patients in the Interventional Neuroradiology Unit between May 2005 and August 2006. Of these, 670 were interventional and 745 were diagnostic cerebral angiographic procedures. In 28 patients bilateral puncture of the femoral arteries was performed for endovascular treatment. In 167 patients 286 repeat diagnostic procedures were performed and 30 interventional procedures were followed by re-closure with an Angio-Seal device at the time of repeat puncture. The procedural success rate for antegrade closures was 99.7% for all procedures. The device failed in 5 of 745 diagnostic procedures (0.7%). Major complication occurred in one patient only (0.13%) in the diagnostic group. No minor complications were observed in this group. In the interventional group, the major complication rate was 1.4% (10 of 698 closures) and the minor complication rate was 2.4% (17 of 698 closures). However, in the subgroup of patients with cerebral aneurysms who received heparin in combination with antiplatelet agents after the procedure, the major complication rate was 5.3%, but in the carotid/vertebral stenting group it was 0.8%. Our experience in a relatively large series of patients shows that the use of the Angio-Seal STS vascular closure device is safe and effective in patients undergoing cerebral diagnostic angiography and neurointerventional procedures with an acceptable rate of complications, although the complication rate was higher in the group of patients who received heparin and/or antiplatelet medication.

Interventional Neuroangiography in Neonates

Two neonates with either vein of Calen aneurysmal malformation or dural sinus malformation (congenital dural arteriovenous fistula at the torcular herophili) are reported. In neonatal interventional neuroangiography, special attention should be paid to body temperature, contrast material, infusion fluid, heparin, and angio-equipment. In the neonatal period, the umbilical approach provides unique access routes to both arterial and venous sides of the cerebral circulation. Among them, transumbilical venous, transcardiac approach through the foramen ovale allows transarterial intervention from the venous side.

"Turf battles" over imaging and interventional procedures in community hospitals: survey results.

A survey of nonacademic community hospitals was conducted to ascertain the degree of control radiologists have of 38 selected imaging or imaging-related interventional procedures. Responses from 187 hospitals showed that community hospital radiologists totally controlled or strongly dominated almost half of these procedures, including all computed tomographic and magnetic resonance imaging studies, bone radiography, breast needle localization, emergency department radiography, arthrography, obstetric ultrasound (US), renal and peripheral angioplasty, percutaneous abscess and biliary drainage, percutaneous nephrostomy, cerebral angiography, and interventional neuroangiography. Radiologists dominated in prostate and vascular US, myelography, urethrography, cardiac nuclear medicine, percutaneous lung biopsy, ureteral stent placement, and pulmonary angiography, but there was also significant participation in these studies by nonradiologists. Radiologists and nonradiologists had roughly equivalent roles in hysterosalpingography, peripheral atherectomy and laser angioplasty, and percutaneous inferior vena cava filter placement. Nonradiologists dominated in echocardiography, endoscopic retrograde cholangiopancreatography, biliary and kidney stone lithotripsy, percutaneous gastrostomy, coronary angiography and angioplasty, and pediatric angiocardiography.