Pediatric diagnostic cerebral angiography: practice recommendations from the SNIS Pediatric Committee.

The pediatric population spans a diverse age group,1 from neonates and infants to adult-sized teenagers, each with unique physiological characteristics that must be considered when performing diagnostic cerebral angiography (DCA). Herein we refer to pediatric patients as under the age of 18 years. Neonates will not be discussed further due to the very limited role of DCA in the absence of planned neurointervention, most commonly for vein of Galen malformations and other high-flow arteriovenous fistulas leading to life-threatening heart failure. The number of pediatric neuroangiography procedures performed continues to grow2 and it is evident that the technical aspects of performing pediatric DCA are highly variable among practitioners, including our own Task Force members. This reflects the diversity of angiographers from different specialties and the varying levels of prior pediatric neuroangiography training and experience. In 2019, the Society of Neurointerventional Surgery (SNIS) surveyed its membership regarding their individual fellowship training and current practice as it relates collectively to pediatric neuroangiography, including both diagnostic and interventional procedures. Unpublished results indicate that pediatric neuroangiography training and current experience is limited across the nation (figure 1). Most respondents (94%) performed pediatric DCA during fellowship, though this experience was mostly limited and low volume. In children under 4 years of age, that experience was further reduced (40%: 0–10 cases; 45%: 11–49 cases). Despite this limited exposure, 76% of respondents reported currently treating pediatric patients, though in more than half (53%), that volume remains low: 0–10 pediatric cases per year. Practice guidelines for cervicocerebral catheter angiography have been published for adults,3 however, no similar recommendations exist for children. Given this information, Pediatric Neurointerventional Task Force Committee members of the SNIS sought to provide a framework with which safe pediatric DCA can be performed, detailing specific procedural considerations as well as peri-procedural evaluation and …