Antibiotic Prophylaxis in Neuroendovascular Procedures: A Comprehensive Review.

Abstract

PURPOSE OF REVIEW: Infection after neuroendovascular procedures is rare, yet practice around antibiotic prophylaxis varies widely. This review appraises evidence regarding prophylactic antibiotics in diagnostic cerebral angiography and therapeutic neuroendovascular interventions, compares practice patterns with interventional radiology and interventional cardiology, and summarizes major society guidelines. RECENT FINDINGS: Across published series totaling approximately 30,000 neuroendovascular procedures, infection rates ranged from 0 to 0.4%, with no measurable difference between procedures performed with or without prophylactic antibiotics. Infections were predominantly minor and limited to access sites. Comparative data from interventional cardiology and interventional radiology show similarly low infection rates. Professional guidelines uniformly discourage routine antibiotic prophylaxis in clean vascular procedures as well as diagnostic angiography, recommending selective use only in clearly defined high-risk patients. Routine pre-procedural antibiotic prophylaxis is not recommended for diagnostic cerebral angiography or for most clean therapeutic neuroendovascular procedures (including coiling/stenting/flow diversion) in the absence of specific high-risk features. Selective prophylaxis may be considered for clearly high-risk patients or situations.