Low infection risk with neurologic endovascular procedures

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1. The overall risk of infection associated with brain and spine angiography as well as endovascular neurointervention is small.

2. Antibiotic prophylaxis should not be used routinely for these procedures.

This study demonstrates a very low infection rate with diagnostic and interventional neuroangiography in the setting of no antibiotic prophylaxis. All infections were limited to the femoral puncture site. No intracranial or spinal infections were observed. This study was limited by its restriction to one neurointerventionalist’s practice and its retrospective nature. It is possible that this physician practices above the standard of care in terms of sterile prep and intraoperative technique. Additionally, if low-dose antibiotic prophylaxis reduces the number of infections to zero within this patient population, the cost of re-intervention required to repair infected femoral sites could outweigh the cost of prophylaxis. Due the low incidence of infection observed in this study, a well-designed randomized control trial demonstrating a 50% reduction in infection rate would require over 23,000 patients to enroll. However, this study examined a large sample size of nearly three thousand patients and found a very low chance of infectious complication, providing fair evidence that antibiotics should not be routinely used for neuroangiography.

Click to read the study in Neurosurgery

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1. The overall risk of infection associated with brain and spine angiography as well as endovascular neurointervention is small.

2. Antibiotic prophylaxis should not be used routinely for these procedures.

This [retrospective, observational] study reviewed 2918 procedures conducted by a single neurointerventionalist over seven years of practice, and included cerebral angiograms, spinal angiograms and neurointerventional procedures. Femoral artery closure devices were used for the majority of operations and no antibiotic prophylaxis was provided. Two infections were associated with interventions (0.2% infection rate) and one was attributed to a diagnostic angiogram (0.05% infection rate). All three involved the arterial puncture site in the setting of arterial closure with Perclose ProGlide device although this closure device was used for most of the reviewed procedures. Two cases required re-intervention: a saphenous vein interposition graft in one patient and an incision and drainage of an abscess in the second. Overall, the infection rate was 0.1%.

In sum: This study demonstrates a very low infection rate with diagnostic and interventional neuroangiography in the setting of no antibiotic prophylaxis. All infections were limited to the femoral puncture site. No intracranial or spinal infections were observed. This study was limited by its restriction to one neurointerventionalist’s practice and its retrospective nature. It is possible that this physician practices above the standard of care in terms of sterile prep and intraoperative technique. Additionally, if low-dose antibiotic prophylaxis reduces the number of infections to zero within this patient population, the cost of re-intervention required to repair infected femoral sites could outweigh the cost of prophylaxis. Due the low incidence of infection observed in this study, a well-designed randomized control trial demonstrating a 50% reduction in infection rate would require over 23,000 patients to enroll. However, this study examined a large sample size of nearly three thousand patients and found a very low chance of infectious complication, providing fair evidence that antibiotics should not be routinely used for neuroangiography.

Click to read the study in Neurosurgery

By Asya Ofshteyn and Allen Ho

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