뇌혈관조영술 후 발생하는 예측하지 못한 시각 합병증 분석

초록

PURPOSE : Complications from transfemoral cerebral angiography (TFCA) have significantly decreased in recent years, which could potentially represent an improvement in equipment and operator’s skill. But unexpected complication which is local or systemic may be inevitable in some cases. The authors analyzed unexpected visual complications following cerebral angiography for one year (single department study). MATERIALS AND METHODS : From May 2012 to Dec. 2013, total 793 cases of TFCA were performed in our clinic (Neurosurgery). Four cases of visual complications were reported. All the symptoms were noticed within one hour after procedure ending time. Two patients complained decreased visual acuity from some branch of central retinal artery occlusion. Visual filed defect was noticed in one patient who has been performed coil embolization of unruptured aneurysm in carotid siphon. The 48-year-old female showed the 4th cranial nerve palsy following diagnostic TFCA. The symptoms have improved gradually, but complete recover have not followed yet, except in the case of the 4th cranial nerve palsy. RESULTS : From this one year-single department study, the rate of unexpected visual complication was about 0.5%. The clinical characteristics are as follows: 1) visual complications are noticed instantaneously after procedure, 2) central retinal artery obstruction is thought to be relevant with thromboembolism during procedure, 3) the long term administration of antiplatelet drugs could not prevent these complications, 4) visual field defect cannot be explained from coil mass effect and compression of ipsilateral optic nerve alone, and 5) the complications have improved gradually, but full recovery is not easy. CONCLUSION : Visual complication following TFCA is a very rare, but can be occurred even if sufficient anti-thromboembolic medication or procedure had done. It is recommend that cautious and safe procedure, and other factors such as contrast media induced toxicity s