Introduction: The utility and risks of performing primary cerebral angiography are often debated given significant improvements in non-invasive cerebrovascular imaging . We aimed to determine national trends in primary cerebral angiography utilization and associated complications from 1999 through 2009.

Methods: The National Inpatient Survey (NIS) was used to identify patients who received primary cerebral angiography from 1999-2009. We observed trends in discharge volume, total mean charge per patient, and post-procedural complications for this patient population. All data was based on sample projections and analyzed using univariate and multivariate regression (SAS).

Results: There were a total of 424,105 discharges indicating primary cerebral angiography nationwide from 1999-2009. The majority of these cases (65%) were in patients older than 55 years. Embolic stroke was the most frequent complication, particularly in the oldest age bracket, occurring in 16,304 patients. The risk for complications increased with age (p<0.0001) and with other underlying health conditions. Pulmonary, deep vein thrombosis, and renal associated comorbidities resulted in the greatest risk for developing post procedural complications. Throughout the study period case volume for cerebral angiography remained constant while total charge per patient increased from $17,365 in 1999 to $45,339 in 2009 (p<0.001).

Conclusions: The utilization of cerebral angiography amongst inpatient population has remained stable over the years. The rising charges in this subset of patients could be secondary to increasing use of coil embolization amongst inpatients with aneurysmal subarachnoid hemorrhage. Risks of embolic stroke with cerebral angiography increase in patients above 55 years of age and amongst those with medical comorbidities. It is important to recognize costs and risks associated with use of cerebral angiography amongst inpatients and situations where non invasive CT and MRI imaging could provide equivalent diagnostic answers.

Patient Care: This research is important is identifying national trends with cerebral angiography utilization amongst inpatients nationally. It will hi-light processes for reducing complications from cerebral angiography by employing its judicious application.

Learning Objectives: 1. Understand trends in cerebral angiography usage amongst inpatients over the years. 2. Recognize increased risk of embolic stroke and other complications with cerebral angiography in older patients given atherosclerotic vascular trees. 3. Identify situations non invasive imaging with CT angiography and MRA could potentially provide safer and faster diagnosis.

References: Willinsky RA, Taylor SM, TerBrugge K, Farb RI, Tomlinson G, Montanera W. Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology 2003;227:522-8. Hoh BL, Cheung AC, Rabinov JD, Pryor JC, Carter BS, Ogilvy CS. Results of a prospective protocol of computed tomographic angiography in place of catheter angiography as the only diagnostic and pretreatment planning study for cerebral aneurysms by a combined neurovascular team. Neurosurgery 2004;54:1329-40; discussion 40-2