Safety of diagnostic cerebral and spinal digital subtraction angiography in a developing country: a single-center experience from Nepal.

Background: In Nepal, a developing country in South East Asia, neurointerventional procedures are still in early stages. Despite progress in noninvasive neurovascular imaging, digital subtraction angiography (DSA) remains the most precise technique for diagnosing vascular disorders within the central nervous system. This article aims to assess the safety of the first 1000 diagnostic procedures conducted after the introduction of interventional neuroradiology practice in a tertiary care setting in Nepal. Methods: A retrospective cross-sectional study included consecutive diagnostic digital subtraction angiography cases between December 2020 and June 2022. Patients with renal insufficiency and abnormal coagulation profiles were excluded. Data analysis involved descriptive statistics using SPSS version 27.0. Results: Of 1000 cases (998 cerebral, 2 spinal), 49.4% were male, with a mean age of 53.99 ± 16.88 years. Cerebral DSA indications included sub arachnoid hemorrhage (49.6%) and ischemic stroke (32.9%). Spinal DSA indications were spinal arteriovenous malformation (2 cases). The diverse findings in the 1000 cases included normal results in 21.9% of cases, middle cerebral artery aneurysms (8.8%), posterior communicating artery aneurysms (5.9%), and anterior communicating artery aneurysms (12.0%). The most common complications observed were puncture site hematoma (0.7%), nausea (0.8%), and increased urinary creatinine for a few days (0.4%). The overall prevalence of complications was 1.9% with no neurological complications. Conclusion: In the context of a developing country like Nepal, where neurointerventional procedures are in their early stages, this study provides insights into the safety of diagnostic cerebral and spinal DSA. While results align with global standards, challenges like limited resources and training in a developing country's healthcare setting should be acknowledged.