Safety and Outcomes of Cerebrovascular Digital Subtraction Angiography

An audit of the procedural aspects, post-operative complications, and outcomes of cerebrovascular digital subtraction angiography

Digital subtraction angiography (DSA) is an invasive technique used to visualise the cerebral vascular anatomy in selected patients. Indications include aneurysm detection, when non-invasive imaging has been negative, or to delineate arteriovenous malformation anatomy prior to treatment. The Society of Interventional Radiology, American Society of Neuroradiology and Society of NeuroInterventional Surgery have published joint quality thresholds for quality assurance from which these audit standards have been derived.

The standard: 

All performed procedures should be in keeping with local indication guidelines

All patients should have written consent documented in the notes

Complication rates should not be in excess of that within the published literature

Diagnostic success rates should be in keeping with that within the published literature

Target: 

100% in line with local guidelines

100% written consent 

Diagnostic success rate ≥ 98%

Neurological complications

Reversible neurological deficit ≤2%

Permanent neurological deficit ≤1%

Access site complications

 Hematoma (requiring transfusion, surgery, or delayed discharge) ≤3%

 Occlusion ≤1%

 Pseudoaneurysm/av fistula ≤1%*

Systemic complications

 Contrast-induced nephropathy ≤5%

 Major contrast reaction ≤5%

Catheter-induced complications

 Arterial dissection/subintimal passage ≤1%

 Subintimal injection contrast ≤1%

Indicators: 

Each component of the target outcomes

Data items to be collected: 

Radiologists’ reports from the procedure, with indication and diagnostic outcome

Collect patient notes for review of consent and post-operative complications

Suggested number: 

100 cases, or all procedures over one year

Review of departmental acceptable indications

Review of the assessment of patient fitness for procedure

Consideration of whether number of cases performed is sufficient to maintain skill base / low complication rate

Consideration of further specialist refresher training

1. Wojak, J. C. et al. Quality Improvement Guidelines for Adult Diagnostic Cervicocerebral Angiography: Update Cooperative Study between the Society of Interventional Radiology (SIR), American Society of Neuroradiology (ASNR), and Society of NeuroInterventional Surgery (SNIS). Journal of Vascular and Interventional Radiology 26, 1596–1608 (2015) https://www.ncbi.nlm.nih.gov/pubmed/26372000

Alexander Beaumont

Co-authors

Asha Neelakantan