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Vascular Interventional Neuro-angiography

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Pediatric Vascular Neurosurgery

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Abstract

Digital subtraction angiography (DSA) is the gold standard for diagnosis and treatment of many intracranial cerebrovascular pathologies. With a growing recognition of pediatric cerebrovascular disorders and advances in endovascular treatments, there has been an increasing number of DSAs performed in children. Although the safety profile of DSA has been well studied in adults, emerging data on the safety of DSA in children shows a relatively strong safety profile. DSA in children poses unique challenges for neurointerventionalists, including the small size and fragility of pediatric vessels, limited application of devices designed for adults to the pediatric population, reduced radiation and contrast dosage, and specific anesthetic considerations. Further, children have unique cerebrovascular pathologies with specific vulnerabilities that may make errors more consequential. Here we discuss the indications, alternatives, and potential complications of DSA in children. We provide suggestions on how to tailor anesthesia, contrast, radiation exposure, femoral access, catheterization, and closures during DSA for the pediatric population.

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References

  1. Burger IM, Murphy KJ, Jordan LC, Tamargo RJ, Gailloud P. Safety of cerebral digital subtraction angiography in children: complication rate analysis in 241 consecutive diagnostic angiograms. Stroke. 2006;37:2535–9.

    Article  PubMed  Google Scholar 

  2. Fung E, Ganesan V, Cox TS, Chong WK, Saunders DE. Complication rates of diagnostic cerebral arteriography in children. Pediatr Radiol. 2005;35:1174–7.

    Article  PubMed  Google Scholar 

  3. Wolfe TJ, Hussain SI, Lynch JR, Fitzsimmons B-F, Zaidat OO. Pediatric cerebral angiography: analysis of utilization and findings. Pediatr Neurol. 2009;40:98–101.

    Article  PubMed  Google Scholar 

  4. Kaufmann TJ, Huston 3rd J, Mandrekar JN, Schleck CD, Thielen KR, Kallmes DF. Complications of diagnostic cerebral angiography: evaluation of 19,826 consecutive patients. Radiology. 2007;243:812–9.

    Article  PubMed  Google Scholar 

  5. Lin N, Smith ER, Scott RM, Orbach DB. Safety of neuroangiography and embolization in children: complication analysis of 697 consecutive procedures in 394 patients. J Neurosurg Pediatr. 2015;26:1–7.

    Google Scholar 

  6. Morris PP. Practical neuroangiography. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2013.

    Google Scholar 

  7. Hoffman CE, Satillan A, Rotman L, Gobin YP, Souweidane MM. Complications of cerebral angiography in children younger than 3 years of age. J Neurosurg Pediatr. 2014;13:414–19.

    Article  PubMed  Google Scholar 

  8. Alexander MJ, Spetzler RF. Pediatric neurovascular disease: surgical, endovascular and medical management. New York: Thieme; 2005.

    Google Scholar 

  9. Lee BC, Park TS, Kaufman BA. MR angiography in pediatric neurological disorders. Pediatr Radiol. 1995;25:409–19.

    Article  CAS  PubMed  Google Scholar 

  10. Zimmerman RA, Bilaniuk LT. Pediatric brain, head and neck, and spine magnetic resonance angiography. Magn Reson Q. 1992;8:264–90.

    CAS  PubMed  Google Scholar 

  11. Zimmerman RA, Bogdan AR, Gusnard DA. Pediatric magnetic resonance angiography: assessment of stroke. Cardiovasc Intervent Radiol. 1992;15:60–4.

    Article  CAS  PubMed  Google Scholar 

  12. Camacho A, Villarejo A, de Aragon AM, Simon R, Mateos F. Spontaneous carotid and vertebral artery dissection in children. Pediatr Neurol. 2001;25:250–3.

    Article  CAS  PubMed  Google Scholar 

  13. Uchino A, Sawada A, Takase Y, Kan Y, Matsuo M, Kudo S. Supra-clinoid cartoid dissection in a pediatric patient. Clin Imaging. 2001;25:385–7.

    Article  CAS  PubMed  Google Scholar 

  14. Yamada I, Nakagawa T, Matsushima Y, Shibuya H. High-resolution turbo magnetic resonance angiography for diagnosis of Moyamoya disease. Stroke. 2001;32:1825–31.

    Article  CAS  PubMed  Google Scholar 

  15. Denecke T, Frush DP, Li J. Eight-channel multidetector computed tomography: unique potential for pediatric chest computed tomography angiography. J Thorac Imaging. 2002;17:306–9.

    Article  PubMed  Google Scholar 

  16. Cohen RA, Frush DP, Donnelly LF. Data acquisition for pediatric CT angiography: problems and solutions. Pediatr Radiol. 2000;30:813–22.

    Article  CAS  PubMed  Google Scholar 

  17. Lichtman JH, Wang Y, Jones SB, Leifheit-Limson EC, Shaw LJ, Vaccarino V, et al. Age and sex differences in inhospital complication rates and mortality after percutaneous coronary intervention procedures: evidence from the NCDR. Am Heart J. 2014;167:376–83.

    Article  PubMed  Google Scholar 

  18. Garson A. The science and practice of pediatric cardiology. 2nd ed. Baltimore: Williams & Wilkins; 1998.

    Google Scholar 

  19. Academy of Pediatrics. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures. Pediatrics. 1992;89:110–5.

    Google Scholar 

  20. Burrows PF, Robertson RL, Barnes PD. Angiography and the evaluateion of cerebraovascular disease in childhood. Neuroimaging Clin N Am. 1996;6:561–88.

    CAS  PubMed  Google Scholar 

  21. Cohen MD. A review of toxicity of nonionic contrast agents in children. Invest Radiol. 1993;28 Suppl 5:S87–93; discussion S94.

    Article  PubMed  Google Scholar 

  22. Saraf R, Shrivastava M, Siddhartha W, Limaye U. Intracranial pediatric aneurysms: endovascualr treatment and its outcome. J Neurosurg Pediatr. 2012;10:230–40.

    Article  PubMed  Google Scholar 

  23. Staley P, Miller JH, Tonkin ILD. Pediatric angiography. Baltimore: Williams & Wilkins; 1982.

    Google Scholar 

  24. Kamiya K, Ozasa K, Akiba S, Niwa O, Kodama K, Takamura N, et al. Long-term effects of radiation exposure on health. Rev Lancet. 2015;386(9992):469–78.

    Article  CAS  Google Scholar 

  25. Gross BA, Orbach DB. Addressing challenges in 4 F and 5 F arterial access for interventional procedures in infants and young children. J Neurointerv Surg. 2014;6:308–13.

    Article  PubMed  Google Scholar 

  26. Orbach DB, Stamoulis C, Strauss KJ, Manchester J, Smith ER, Scott RM, et al. Neurointerventions in children: radiation exposure and its import. Am J Neuroradiol. 2013;35:650–6.

    Article  PubMed  Google Scholar 

  27. Vranicar M, Hirsch R, Canter CE, Balzer T. Selective coronary angiography in pediatric patients. Pediatr Cardiol. 2000;21:285–8.

    Article  CAS  PubMed  Google Scholar 

  28. Cetta F, Graham LC, Eidem BW. Gaining vascular access in pediatric patients: use of the PD access Doppler needle. Catheter Cardiovasc Interv. 2000;51:61–4.

    Article  CAS  PubMed  Google Scholar 

  29. Lobe TE, Schropp KP, Rogers DA, Rao BNA. “Smart needle” to facilitate difficult vascular access in pediatric patients. J Pediatr Surg. 1993;28:1401–2.

    Article  CAS  PubMed  Google Scholar 

  30. Kocis KC, Snider AR, Vermilion RP, Beekman RH. Two-dimensional and Doppler ultrasound evaluation of femoral arteries in infants after cardiac catheterization. Am J Cariol. 1995;75:642–5.

    Article  CAS  Google Scholar 

  31. Ball Jr WS. Cerebrovascular occlusive disease in childhood. Neuroimaging Clin N Am. 1994;4:393–421.

    PubMed  Google Scholar 

  32. Flanigan DP, Keifer TJ, Schuler JJ, Ryan TJ, Castronuovo JJ. Experience with iatrogenic pediatric vascular injuries. Incidence, etiology, management, and results. Ann Surg. 1983;198:430–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Lock JE, Keane JF, Perry SB. Diagnostic and interventional catheterization in congenital heart disease. 2nd ed. Boston: Kluwer Academic; 2000.

    Book  Google Scholar 

  34. Deshaies EM, Eddleman CS, Boulos AS. Handbook of neuroendovascular surgery. New York: Thieme; 2012.

    Google Scholar 

  35. Chait P. Future directions in interventional pediatric radiology. Pediatr Clin North Am. 1997;44:763–82.

    Article  CAS  PubMed  Google Scholar 

  36. Petterson H, Fitz CR, Harwood-Nash DC, Chuang S, Armstrong E. Iatrogenic embolization: complication of pediatric cerebral angiography. AJNR Am J Neuroradiol. 1981;2:357–61.

    Google Scholar 

  37. Gerlock AJ, Mirfakhraee M. Essentials of diagnostic and interventional angiographic techniques. Philadelphia: Saunders; 1985.

    Google Scholar 

  38. Ellis MJ, Amlie-Lefond C, Orbach DB. Endovascular therapy in children with acute ischemic stroke: review and recommendations. Neurology. 2012;79(suppl1):S158–64.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Duke University Hospitals, Department of Neurosurgery, Durham, NC, USA

    Mary I. H. Cobb, Ali R. Zomorodi & Luiz F. Gonzalez

  2. Duke University Hospitals, Department of Radiology, Division of Interventional Radiology, Durham, NC, USA

    Patrick A. Brown & Tony P. Smith

Authors
  1. Mary I. H. Cobb
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  2. Patrick A. Brown
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  3. Tony P. Smith
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  4. Ali R. Zomorodi
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  5. Luiz F. Gonzalez
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Correspondence to Mary I. H. Cobb .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Methodist Neurological Institute, Houston, Texas, USA

    Abhishek Agrawal

  2. Department of Neurosurgery, Methodist Neurological Institute, Houston, Texas, USA

    Gavin Britz

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© 2016 Springer International Publishing Switzerland

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Cobb, M.I.H., Brown, P.A., Smith, T.P., Zomorodi, A.R., Gonzalez, L.F. (2016). Vascular Interventional Neuro-angiography. In: Agrawal, A., Britz, G. (eds) Pediatric Vascular Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-43636-4_8

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  • DOI: https://doi.org/10.1007/978-3-319-43636-4_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43634-0

  • Online ISBN: 978-3-319-43636-4

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