Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation - A meta-analysis

Background and Purpose - A well-defined complication rate of cerebral angio graphy in patients with subarachnoid hemorrhage (SAH), cerebral aneurysm, a nd arteriovenous malformation (AVM) would be useful to physicians making de cisions regarding the imaging of these patients. We sought to define a stat istically significant complication rate through meta-analysis of prospectiv e studies in the literature. Methods - Meta-analysis of 3 published prospective studies of complications in cerebral angiography was performed to specifically define the risk of c erebral angiography in patients presenting with SAH, cerebral aneurysm, and AVM. The complication rates for cerebral angiography in patients with SAH and AVM/aneurysm without SAH were compared with the complication rates in p atients who underwent cerebral angiography for transient ischemic attack (T IA)/ischemic stroke with use of the Fisher exact test. Results - The combined risk of permanent and transient neurological complic ation was significantly lower in patients with SAH compared with patients w ith TIA/stroke (1.8% versus 3.7%; P = 0.03). The combined risk of permanent and transient neurological complication was significantly lower in patient s with aneurysm/AVM without SAH compared with patients with TIA/stroke (0.3 % versus 3.7%; P = 0.001). When the patients with SAH and cerebral aneurysm /AVM were combined, the overall risk of permanent and transient neurologica l complication was significantly lower than for the TIA/stroke patients (0. 8% versus 3.0%; P = 0.001), as was the risk of permanent neurological compl ication (0.07% versus 0.7%; P = 0.004). Conclusions - The risk of permanent neurological complication associated wi th cerebral angiography in patients with SAH, cerebral aneurysm, and AVM is quite low (0.07%). This risk is lower than previously recognized.