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Iatrogenic ischemic cerebral infarction — Clinical Guidelines

Overview

Iatrogenic ischemic cerebral infarction refers to brain tissue damage caused by reduced blood flow due to medical procedures, often associated with neurointerventional techniques such as endovascular interventions. 2 6

Diagnosis

Clinical Presentation: Symptoms may include sudden neurological deficits consistent with stroke.

Imaging: MRI or CT scans to identify areas of ischemia.

Angiographic Parameters: Monitoring exposure time, dose-area product (DAP), and number of digital subtraction angiography (DSA) studies/frames can help identify procedural risk factors. 7

Management

Procedural Safety: Implementation of structured safety checklists to minimize errors. 2

Team Training: Utilize Crew Resource Management (CRM) principles to enhance team effectiveness and error recognition. 4

Radiation Protection: Use of dosimeters to monitor and manage radiation exposure for both patients and operators. 7

Special Populations

Operator Safety: Consideration of operator radiation exposure, particularly in left upper extremities, during prolonged procedures. 7

Key Recommendations

Implement Comprehensive Safety Checklists during neurointerventional procedures to reduce procedural errors and enhance patient safety. (Evidence: Strong 2)

Integrate Crew Resource Management (CRM) training into neurointerventional teams to improve communication and error prevention. (Evidence: Moderate 4)

Monitor and Manage Radiation Exposure for both patients and operators using advanced dosimetry techniques to mitigate long-term risks. (Evidence: Moderate 7)

References

1 Yabut JM, Al Bader R, Affana C, Chainey J, Kumar A. Trainee and Faculty Perspectives of Neurointerventional Curricula in Residency: a Scoping Review. The clinical teacher 2026. link 2 Chen M, Fargen KM, Mocco J, Siddiqui AH, Miyachi S, Mahadevan J et al.. World federation of interventional and therapeutic neuroradiology (WFITN) federation assembly neurointerventional surgery safety checklist. Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences 2025. link 3 Hirsch JA, Donovan WD, Leslie-Mazwi TM, Nicola GN, Manchikanti L, Silva E. Component coding and the neurointerventionalist: a tale with an end. Journal of neurointerventional surgery 2013. link 4 Miguel K, Hirsch JA, Sheridan RM. Team training: a safer future for neurointerventional practice. Journal of neurointerventional surgery 2011. link 5 Manchikanti L, Hirsch JA. Medicare physician payment rules for 2011: a primer for the neurointerventionalist. AJNR. American journal of neuroradiology 2011. link 6 Gomez MA, Byers EJ, Stingley P, Sheridan RM, Hirsch JA. Establishing operational stability--developing human infrastructure. Journal of neurointerventional surgery 2010. link 7 Moritake T, Matsumaru Y, Takigawa T, Nishizawa K, Matsumura A, Tsuboi K. Dose measurement on both patients and operators during neurointerventional procedures using photoluminescence glass dosimeters. AJNR. American journal of neuroradiology 2008. link

Iatrogenic ischemic cerebral infarction