Clinical and subclinical microemboli following neuroangiography in children

BackgroundTo assess the frequency, imaging appearances, and risk factors of brain microemboli following pediatric neuroangiography, as assessed by early diffusion-weighted MRI imaging (DWI). MethodsThis single-center, retrospective analysis investigated early DWI post-pediatric neuroangiography. Patients aged 0-18 years who had diagnostic neuroangiography and DWI within a week postprocedure were included. Data on clinical and procedural parameters and MRI findings were recorded. Univariate and multivariate analyses were performed on the following risk factors: age, weight, vasculopathy, antiplatelet drug use, access type, intraprocedural heparin, procedure duration, neck arteries catheterized, and angiographic runs. A p-valueResultsEighty-two children were included (40.2% female), mean age 10.1 & PLUSMN;4.5 years (range: 7 months-17 years). There were no intraprocedural thromboembolic complications recognized. DWI positivity was seen following 3.6% (3/82) procedures: two with transient symptoms, and one instance of silent microemboli. There were no territorial infarcts or clinical stroke. Children with underlying vasculopathy had a higher risk of microemboli from angiography than children without vasculopathy (OR 31.6, p=0.02), and the OR of microemboli following transradial angiography was 79.1 (p=0.005) as compared with transfemoral angiography. Univariate and multivariate analysis showed a significant association between microemboli and number of angiographic runs (p=0.004). Follow-up MRI in all three patients showed no residual abnormal signal. ConclusionsCerebral microemboli are unusual following uncomplicated neuroangiography in children. However, in the presence of underlying vasculopathy and with transradial technique, the incidence approaches that reported in the adult literature. An increased association with the number of angiographic runs is an important and controllable factor.

Automated summary

This retrospective study aimed to assess the frequency, imaging appearances, and risk factors of brain microemboli following pediatric neuroangiography using early diffusion-weighted MRI imaging. The study found that the occurrence of cerebral microemboli is uncommon in children after uncomplicated neuroangiography. However, the incidence approaches that reported in adults when there is underlying vasculopathy and the transradial technique is used. Additionally, there is a significant association between the number of angiographic runs and microemboli.