Increased risk for complications following diagnostic cerebral angiography in older patients: Trends from the Nationwide Inpatient Sample (1999–2009)

• Non-invasive cerebrovascular imaging techniques are reshaping clinical practice.
• We examined trends in cerebral angiography from nationwide discharge data.
• From 1999–2009 patient volume remained constant while cost per patient increased.
• Embolic stroke was the most common complication, particularly in older patients.
• Cerebral angiography comes with complication risks for older and sicker patients.

The full utility of diagnostic cerebral angiography, an invasive cerebrovascular imaging technique, is currently debated. Our goal was to determine trends in diagnostic cerebral angiography utilization and associated complications from 1999 through 2009. The National Inpatient Sample (NIS) was used to identify patients who received primary cerebral angiography from 1999–2009 in the United States. We observed trends in discharge volume, total mean charge, and post-procedural complications for this population. Data was based on sample projections and analyzed using univariate and multivariate regression. 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). While the overall complication rate for this invasive procedure is relatively low, the potential risk for embolic stroke in older patients is significant. It is worth considering less invasive diagnostic techniques for an older and at risk patient population.