Question 2: Neurological complications of diagnostic cerebral catheter angiography in children

An 8-year-old boy is currently an inpatient in your paediatric unit having had a sudden onset of left sided weakness after a roller-coaster ride. Brain MRI has shown this to be due to a right-sided pontine infarct; brain and neck magnetic resonance angiography (MRA) were normal. Assessment has not identified any risk factors for arterial ischaemic stroke (AIS). Transfer has been arranged to the tertiary centre, where the paediatric neurologists are planning to request diagnostic catheter cerebral angiography (CA) to exclude vertebral artery dissection. The child's parents are apprehensive about this and would like to know the risks of this procedure, especially as they have heard these potentially include neurological complications. In a child with suspected cerebral arteriopathy (patient) undergoing diagnostic catheter angiography (intervention), what is the risk of neurological complications (outcome)? Using the PubMed, Medline and EMBASE databases, the terms ‘CA’, ‘digital subtraction angiography’ and ‘cerebral arteriography’ were sequentially paired with the qualifiers ‘adverse effects’, ‘complications’, ‘side effects’ and ‘safety’. The results were filtered by age, to include subjects under the age of 19 years. In total this yielded 149 papers, the abstracts of which were reviewed. The majority of these featured adults and so were excluded. Papers detailing complications of interventional CA were also excluded. Four relevant studies remained, each published within the last 15 years and documenting the complications of diagnostic CA in children. We also identified several other papers which were of interest without directly contributing to our structured clinical question. These will be briefly …