Safety of spinal angiography: complication rate analysis in 302 diagnostic angiograms

Neurology. 2011 Sep 27;77(13):1235-40. doi: 10.1212/WNL.0b013e3182302068. Epub 2011 Sep 14.


Objective: Spinal digital subtraction angiography (SpDSA) continues to be the imaging gold standard for the evaluation of spinal cord vascular disorders. The safety of this procedure has a poor historical reputation and there are few current reports on complication rates. We hypothesized that modern SpDSA can be performed with an acceptably low risk of iatrogenic complications.

Methods: In this retrospective series, we reviewed 302 consecutive spinal angiograms performed during a 10-year period at our institution for the frequency of intraprocedural and postprocedural neurologic, non-neurologic, and local complications. Indications for SpDSA, prior noninvasive imaging findings, and angiographic diagnoses for each case were assessed to evaluate the diagnostic contribution of the procedure.

Results: There were no intraprocedural or postprocedural neurologic complications in the studied cohort. Systemic complications occurred in 2 cases (0.7%), in the form of back spasms in one patient and pulmonary edema in the other. Both recovered promptly and were discharged at baseline status. Access-site complications included 3 groin hematomas (1.0%), all managed conservatively. MRI findings showed 51% sensitivity and 83% specificity for spinal vascular malformations. A total of 31% of patients with the preangiographic diagnosis of transverse myelitis were found to have a vascular malformation.

Conclusion: SpDSA carries very low risks of neurologic and systemic complications, while offering a gold-standard level of diagnostic confidence for the evaluation of the normal and pathologic vasculature of the spinal cord.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Angiography, Digital Subtraction / adverse effects*
  • Angiography, Digital Subtraction / statistics & numerical data
  • Central Nervous System Vascular Malformations / complications
  • Central Nervous System Vascular Malformations / diagnostic imaging
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Longitudinal Studies
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Retrospective Studies
  • Spinal Cord / diagnostic imaging*
  • Spinal Cord / pathology
  • Spinal Cord Diseases / classification
  • Spinal Cord Diseases / diagnosis*
  • Vertebral Artery / diagnostic imaging
  • Vertebral Artery / pathology
  • Young Adult