Who Performs Catheter Cerebral Angiography
Catheter cerebral angiography is performed by multiple specialists with appropriate training and credentialing, including interventional neuroradiologists, interventional neurologists, interventional cardiologists, vascular surgeons, and neurosurgeons who have completed specific competency requirements in cervicocerebral angiography. 1
Training Requirements and Competency Standards
The multispecialty consensus from the American College of Cardiology, Society for Cardiovascular Angiography and Interventions, and Society for Vascular Surgery establishes clear training benchmarks 1:
- Interventionalists with existing catheter-based skills in other vascular beds can achieve competency by performing 30 supervised cervicocerebral angiograms, with at least 15 as primary operator 1
- Prior to performing these supervised cases, trainees must acquire extensive knowledge of neurovascular anatomy and pathology through formal study 1
- The transferable nature of advanced catheter skills from other vascular territories is explicitly recognized, as demonstrated by excellent outcomes in major trials (SAPPHIRE, BEACH, SECURITY, ARCHER) where cardiologists, surgeons, and vascular interventionalists performed cerebral angiography 1
Specialty-Specific Performance Data
Neurointerventionalists (typically neuroradiologists or interventional neurologists with fellowship training) demonstrate the lowest complication rates:
- Academic neurointerventional specialists achieved a 0.30% clinical complication rate in 3,636 procedures 2
- Permanent neurological deficit rate of 0.14% with stroke rate of 0.03% 2
Interventional neurologists performing cerebral angiography show comparable safety:
- Permanent neurological deficit in 0.2% of 661 procedures 3
- Major non-neurological complications in 0.9% 3
- These rates meet or exceed established safety guidelines 3
Clinical Context and Operator Selection
The American Heart Association/Stroke Council recognizes that selective catheter cerebral angiography remains the gold standard for diagnosing cerebral aneurysms and vascular abnormalities 1. The procedure should be performed by operators who:
- Understand neurovascular anatomy and collateral circulation pathways 1
- Can recognize intracranial pathology including aneurysms, arteriovenous malformations, stenosis, and embolic occlusions 1
- Have demonstrated competence in both performance and interpretation of diagnostic studies 1
Important Caveats
Age-related risk: Patients over 65 years have significantly higher complication rates (p=0.03), requiring more experienced operators 2
Trainee involvement paradox: Contrary to intuition, trainee involvement in procedures was associated with decreased neurologic complications (OR 0.710), likely reflecting more careful technique and closer supervision 4
Evolving role: While CTA and MRA have reduced the volume of purely diagnostic angiography, catheter angiography still provides new clinically meaningful findings in 43% of diagnostic cases and 32% of surveillance studies, with false-negative rates of 9.9% for noninvasive imaging 5