Ischaemic brain changes associated with catheter-based diagnostic cerebral angiography: a diffusion-weighted imaging study

PURPOSE: This study aims to evaluate the incidence of clinically silent embolic cerebral infarctions and associated risk factors following diagnostic cerebral angiography with diffusion-weighted imaging (DWI). MATERIAL AND METHODS: A total of 71 cerebral digital subtraction angiograms (42 male, 29 female, average age: 56.0 ± 15.0) obtained using nonionic contrast material were prospectively evaluated. To assess embolic events, before and after (1-3 days) angiography, DWI was performed. The risk factors for embolic ischemic brain changes such as the patient’s age and sex, atherosclerotic vessel wall disease, type of indication for catheter angiography, the number and size of the catheters, anatomic variants, selective/nonselective catheterization, contrast media volume, and time of procedure were determined. Fisher’s exact tests and Student t-tests were used for the statistical analyses of outcomes. RESULTS: Thirteen new silent ischemic lesions were identified in 7 out of 71 patients who underwent diagnostic cerebral angiography. Embolic cerebral lesions were often 6-10mm in diameter. According to the findings in this study, there was a strong correlation between diffusion abnormality and patient age, which was considered risk factors (p < 0.05). However, there were no significant correlations between other risk factors and the lesions’ appearance (p > 0.05). CONCLUSIONS: In elderly patients, the angiographic procedures should be performed meticulously and DWI in all patients obtained routinely, even if the regular neurological examination shows they are healthy. In this way, the presence of microemboli and clinical results can be evaluated.