gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Silent microemboli related to diagnostic cerebral angiography. A matter of operator’s experience and patient’s disease

Stille Mikroembolien bei diagnostischen zerebralen Angiographien: Einflüsse der Erfahrung des Untersuchers und der Erkrankung des Patienten

Meeting Abstract

  • corresponding author M.H.T. Reinges - Neurochirurgische Klinik, Universitätsklinikum Aachen
  • R. Becker - Abteilung Neuroradiologie, Universitätsklinikum Aachen.
  • F.-J. Hans - Neurochirurgische Klinik, Universitätsklinikum Aachen
  • M. Mull - Abteilung Neuroradiologie, Universitätsklinikum Aachen.
  • T. Krings - Neurochirurgische Klinik, Universitätsklinikum Aachen

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 10.163

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Reinges et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Up to now, no studies that have investigated whether the occurrence of silent microemboli in diagnostic cerebral angiographies is related to the operators’s experience. All previous studies included both diagnostic and interventional procedures in their evaluation, the latter being associated with a higher risk of micoremboli but being typically performed by more experienced investigators. Thereby, possible correlations between the occurrence of DWI lesions and the experience of the investigator were likely to be biased. The aim of the present investigation was to elucidate in a large consecutive patient cohort whether the level of training has an effect on the number of microemboli detected by DWI and which additional risk factors can be identified.

Methods: 107 consecutive patients in whom a diagnostic cerebral angiography was performed were prospectively investigated with DWI, 51 angiographies were performed by experienced neuroradiologists, 56 by neuroradiologists in training.

Results: In 12 (11.1%) patients a total of 17 new lesions without any clinically overt neurological symptoms were identified. Of those, 11 patients with 16 lesions were investigated by junior neuroradiologists. In 11 patients risk factors could be identified (atherosclerotic vessel wall disease, vasculitis, hypercoaguable states).

Conclusions: The level of experience and the nature of the underlying disease are predictors of the occurrence of cerebral ischemic events following neuroangiography. Alternative diagnostic modalities should be employed in patients who are investigated for those diseases that are at highest risk for angiographic complications, i.e. vasculitis, and arteriosclerotic vessel wall disease. If diagnostic angiography remains necessary in these patients, the highest level of practitioner training should be required to ensure proper patient outcome.