MICROSCOPIC AIR-EMBOLISM DURING CEREBRAL-ANGIOGRAPHY AND STRATEGIES FOR ITS AVOIDANCE

被引:113
作者
MARKUS, H
LOH, A
ISRAEL, D
BUCKENHAM, T
CLIFTON, A
BROWN, MM
机构
[1] ATKINSON MORLEYS HOSP,DEPT NEURORADIOL,LONDON SW20,ENGLAND
[2] ST GEORGE HOSP,DEPT SURG,LONDON SW17 0RE,ENGLAND
[3] ST GEORGE HOSP,DEPT RADIOL,LONDON SW17 0RE,ENGLAND
关键词
D O I
10.1016/0140-6736(93)90561-T
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Cerebral angiography is associated with a risk of neurological complications and air embolism may contribute towards this risk. To test this hypothesis, transcranial doppler ultrasonography was used to monitor the presence of air emboli in the middle cerebral arteries of 7 patients undergoing cerebral angiography. Doppler signals consistent with numerous air emboli were noted during each injection of radiographic contrast. This phenomenon was studied further in sheep. Radiographic contrast medium was injected into the carotid artery while a major carotid branch was insonated transorbitally. Embolic signals similar to those seen in patients were noted. Air was introduced at two points. First, at the time of drawing up the contrast into the syringe, especially with more viscous media. Standing the media before injection resulted in a highly significant reduction of air embolism, reducing the total mean duration of emboli from 1.32 (SD 0.60) s after immediate injection to 0.04 (0.05) s after ten minutes standing for iohexol 340 mg/mL (p < 0.001 ). Second, air was introduced at the time of injection, possibly by the formation of cavitation bubbles under pressure. This occurred most prominently with the less viscous contrast media and with saline, and was significantly reduced by slow injection (mean duration of emboli for saline 2.85 [2.43] s with fast injection compared with 0.32 [0.37] s with slow injection, p = 0.004). Air embolism may contribute towards neurological dysfunction after angiography. Measures should be taken to reduce this by allowing contrast media to stand prior to injection, and by flushing catheters with saline injected slowly.
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收藏
页码:784 / 787
页数:4
相关论文
共 21 条
  • [1] AUSTEN WG, 1965, J SURG RES, V5, P283
  • [2] NATURAL-HISTORY OF CEREBRAL COMPLICATIONS OF CORONARY-ARTERY BYPASS GRAFT-SURGERY
    COFFEY, CE
    MASSEY, EW
    ROBERTS, KB
    CURTIS, S
    JONES, RH
    PRYOR, DB
    [J]. NEUROLOGY, 1983, 33 (11) : 1416 - 1421
  • [3] CLINICAL EVENTS FOLLOWING NEUROANGIOGRAPHY - A PROSPECTIVE-STUDY
    DION, JE
    GATES, PC
    FOX, AJ
    BARNETT, HJM
    BLOM, RJ
    [J]. STROKE, 1987, 18 (06) : 997 - 1004
  • [4] CLINICAL AND INSTRUMENTAL EVALUATION OF PATIENTS WITH ISCHEMIC STROKE WITHIN THE 1ST 6 HOURS
    FIESCHI, C
    ARGENTINO, C
    LENZI, GL
    SACCHETTI, ML
    TONI, D
    BOZZAO, L
    [J]. JOURNAL OF THE NEUROLOGICAL SCIENCES, 1989, 91 (03) : 311 - 322
  • [5] ARTERIAL AIR-EMBOLISM IN THE CAT BRAIN
    FRITZ, H
    HOSSMANN, KA
    [J]. STROKE, 1979, 10 (05) : 581 - 589
  • [6] PROCEDURE FOR TESTING HOMOGENEITY OF ALL SETS OF MEANS IN ANALYSIS OF VARIANCE
    GABRIEL, KR
    [J]. BIOMETRICS, 1964, 20 (03) : 459 - &
  • [7] CEREBRAL ANGIOGRAPHIC RISK IN MILD CEREBROVASCULAR-DISEASE
    HANKEY, GJ
    WARLOW, CP
    SELLAR, RJ
    [J]. STROKE, 1990, 21 (02) : 209 - 222
  • [8] MARKUS HS, 1993, STROKE, V24, P1
  • [9] INTRACAROTID AIR EMBOLISM IN BABOON - EFFECTS ON CEREBRAL BLOOD FLOW AND ELECTROENCEPHALOGRAM
    MELDRUM, BS
    PAPY, JJ
    VIGOUROUX, RA
    [J]. BRAIN RESEARCH, 1971, 25 (02) : 301 - +
  • [10] CEREBRAL AIR-EMBOLISM - REPORT OF 5 CASES AND REVIEW OF LITERATURE
    MENKIN, M
    SCHWARTZMAN, RJ
    [J]. ARCHIVES OF NEUROLOGY, 1977, 34 (03) : 168 - 170