Safety of Digital Subtraction Angiography for Cerebrovascular Disorders in Lahore

Background and objective Despite the usefulness of noninvasive vascular imaging modalities, Digital Subtraction Angiography (DSA) remains the gold standard imaging technique for cerebrovascular disorders. In contrast to developed countries, the safety of DSA is not extensively reported from developing countries. The purpose of this study was to evaluate the safety of diagnostic angiography procedures performed at a large public sector teaching hospital. Methods We conducted a retrospective review of patient demographics, indications and complications for a consecutive cohort of 1,238 patients undergoing digital subtraction angiography at a comprehensive stroke center in Lahore, Pakistan, from June 2023 to July 2025. Complications related to the catheter technique and sheath placement were also studied. All procedures were directly supervised by a credentialed US‐trained neurointerventionalist. Results The mean age for patients undergoing DSA was 42 years. Of all the 1238 patients, 684 (55.3%) were female and 553 (44.7%) were male. Cerebral DSA was performed in 1229 (99.3%), while 9 were spinal DSA (0.7%). Cerebral aneurysms constituted the most common indication for DSA, accounting for 760 cases (61.4%) [81.6% ruptured, 18.3% unruptured], followed by arteriovenous malformations 195 (15.7%), arteriovenous fistulas 62 (5%), acute stroke 47 (3.7%), tumors 39 (3.1%) and atherosclerotic vascular disease 27 (2.18%). Less common indications were Moyamoya disease, Vein of Galen Malformation and pseudoaneurysms. Out of 31 carotid‐cavernous AVFs, 76% were type A. About 5.4% patients were observed to have fetal PCA, while 1.9% had near fetal PCA. A total of 67 (5.4%) DSAs were unremarkable for any significant pathology. None of the patients developed any transient or permanent neurologic complications. Non‐neurologic complications encountered were six cases of asymptomatic femoral artery dissections (0.4%) and four groin hematomas (0.3%). No death was reported as a complication of the procedure. Conclusion Diagnostic cerebral and spinal DSA procedures performed in a developing country were shown to be safe, with complication rates comparable to those observed in the developed world. Operator training, as well as trained paramedical staff and the availability of essential disposable inventory, were found to directly impact procedural outcomes.