Safety of Cerebral Digital Subtraction Angiography in Pediatric Patients with Sickle Cell Disease....
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![Page 1: Safety of Cerebral Digital Subtraction Angiography in Pediatric Patients with Sickle Cell Disease. Emily Wyse, BS 1 Jessica Carpenter, MD 2 Suresh Magge,](https://reader036.fdocuments.net/reader036/viewer/2022062401/5a4d1b547f8b9ab0599a8a4a/html5/thumbnails/1.jpg)
Safety of Cerebral Digital Subtraction Angiography in Pediatric Patients with Sickle Cell Disease.
Emily Wyse, BS1
Jessica Carpenter, MD2
Suresh Magge, MD2
Ross Fasano, MD2
Monica Pearl, MD1,2
EP – 117
1. Division of Interventional Neuroradiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
2. Department of Interventional Neuroradiology, Children’s National Medical Center, Washington, DC, USA
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No disclosure
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Background
Neurologic complications of sickle cell disease (SCD) have an 11% chance of occurring in a patient by age 20.1
These events most commonly include stroke, hemorrhage, and cognitive and behavioral changes.
1. Ohene-Frempong K, Weiner SJ, Sleeper LA, et al. Cerebrovascular accidents in sickle cell disease: rates and risk factors. Blood. 1998;91(1):288-294.
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Background
The evaluation of pediatric patients with SCD and a neurologic condition is routinely performed with non-invasive imaging such as CT, MRI or transcranial doppler.
Cerebral digital subtraction angiography (DSA), a minimally invasive procedure, is often not considered due to concerns for intravascular sickling and other complications.
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Purpose
We present a series of pediatric SCD
patients who underwent cerebral DSA to
evaluate the safety of this procedure.
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Materials and Methods
We reviewed a prospective database
from July 2010 to December 2014 of
all children with SCD who underwent
diagnostic or interventional cerebral
DSA at a single institution.
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Materials and Methods
Records were reviewed for age, gender,
clinical diagnosis, and intra-procedural or
post-procedural complications.
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Results
Total angiograms: 41 Total patients: 28 (17 boys, 11 girls)
Age range: 3 to 18 years
Median age: 10 years
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Diagnostic angiographyPerformed for the following clinical diagnoses:
Moyamoya syndrome: n = 6
Stroke: n = 7
Intracranial aneurysm: n = 9
SAH: n = 2
Vasculopathy: n = 4
A, B) Multiple intracranial aneurysms (arrows) are noted in two patients with SCD. The largest is a superiorly projecting ophthalmic segment aneurysm (asterisk).
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InterventionsPerformed for the following diagnoses:
Intra-arterial nicardipine infusion for vasospasm due to SAH: n = 3
Coil embolization for ruptured aneurysms: n = 1
Coil embolization for unruptured aneurysms: n = 1
Stent-assisted coil embolization for unruptured aneurysm: n = 1
Posteroanterior (C) and lateral (D) views from a right internal carotid artery injection show diffuse vasospasm in a child with SCD and diffuse SAH.
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Results
No intra-procedural complications for diagnostic or interventional cases.
Post-procedure, one child suffered from a sickle cell crisis (acute chest syndrome) which resulted in reintubation and an additional night in the PICU.
No groin hematomas, strokes, or intracranial hemorrhages.
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Discussion
Pre-procedural preparation includes adequate hydration and optimizing hematologic parameters.
Hydration: IV fluids at 1.5 times the maintenance rate. If elective, children were admitted the night prior to the procedure.1
Hematology: transfusion goal of hemoglobin greater than 10 g/dL and HbS less than 30%.1
1. Saini S, Speller-Brown B, Wyse E, et al. Unruptured intracranial aneurysms in children with sickle cell disease: Analysis of 18 aneurysms in 5 patients. Neurosurgery. 2015.
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Conclusion
Cerebral DSA can be performed safely in
pediatric patients with SCD and should be
considered in the evaluation of
cerebrovascular pathologies in this population.