Bendszus Martin, Koltzenburg Martin, Bartsch Andreas J, Goldbrunner Roland, Günthner-Lengsfeld Thomas, Weilbach Franz X, Roosen Klaus, Toyka Klaus V, Solymosi László
Department of Neuroradiology, University of Würzburg, Josef-Schneider-Strasse 11, D-97080 Würzburg, Germany.
Circulation. 2004 Oct 12;110(15):2210-5. doi: 10.1161/01.CIR.0000144301.82391.85. Epub 2004 Oct 4.
Intra-arterial cerebral angiography is associated with a low risk for neurological complications, but clinically silent ischemic events after angiography have been seen in a substantial number of patients.
In a prospective study, diffusion-weighted magnetic resonance imaging (DW-MRI) before and after intra-arterial cerebral angiography and transcranial Doppler sonography during angiography were used to evaluate the frequency of cerebral embolism. One hundred fifty diagnostic cerebral angiographies were randomized into 50 procedures, each using conventional angiographic technique, or systemic heparin treatment throughout the procedure, or air filters between the catheter and both the contrast medium syringe and the catheter flushing. There was no neurological complication during or after angiography. Overall, DW-MRI revealed 26 new ischemic lesions in 17 patients (11%). In the control group, 11 patients showed a total of 18 lesions. In the heparin group, 3 patients showed a total of 4 lesions. In the air filter group, 3 patients exhibited a total of 4 lesions. The reduced incidence of ischemic events in the heparin and air filter groups compared with the control group was significantly different (P=0.002). Transcranial Doppler sonography demonstrated a large number of microembolic signals that was significantly lower in the air filter group compared with the heparin and control groups (P<0.01), which did not differ from each other.
Air filters and heparin both reduce the incidence of silent ischemic events detected by DW-MRI after intra-arterial cerebral angiography and can potentially lower clinically overt ischemic complications. This may apply to any intra-arterial angiographic procedure.
动脉内脑血管造影术的神经并发症风险较低，但大量患者在造影术后出现了临床无症状的缺血性事件。
在一项前瞻性研究中，采用动脉内脑血管造影术前、后的扩散加权磁共振成像（DW-MRI）以及造影术中的经颅多普勒超声检查来评估脑栓塞的发生率。150例诊断性脑血管造影随机分为50例，分别采用传统血管造影技术、全程系统性肝素治疗或在导管与造影剂注射器及导管冲洗装置之间使用空气过滤器。造影术中及术后均未出现神经并发症。总体而言，DW-MRI显示17例患者（11%）出现26个新的缺血性病灶。对照组中，11例患者共出现18个病灶。肝素组中，3例患者共出现4个病灶。空气过滤器组中，3例患者共出现4个病灶。与对照组相比，肝素组和空气过滤器组缺血事件发生率降低，差异有统计学意义（P = 0.002）。经颅多普勒超声检查显示大量微栓子信号，空气过滤器组显著低于肝素组和对照组（P < 0.01），肝素组和对照组之间无差异。
空气过滤器和肝素均可降低动脉内脑血管造影术后DW-MRI检测到的无症状缺血事件的发生率，并可能降低临床明显的缺血性并发症。这可能适用于任何动脉内血管造影术。
