Technical Performance and Interpretation of Digital Subtraction Angiography to Determine Cerebral Circulatory Arrest in Patients Being Evaluated for Brain Death/Death by Neurological Criteria: A Brief Practice Update From the Society of Vascular and Interventional Neurology (SVIN).

backgroundThe Society of Vascular and Interventional Neurology (SVIN) Guidelines and Practice Standards Committee issues Brief Practice Updates to provide concise, evidence-based recommendations and suggestions on focused topics relevant to vascular and interventional neurology. Currently, there is limited published guidance on the technical performance and interpretative parameters of cerebral digital subtraction angiography for the determination of cerebral circulatory arrest in patients being evaluated for brain death/death by neurological criteria. In this Brief Practice Update, we present consensus-based suggestions for standardizing the performance, interpretation, and application of digital subtraction angiography in this context.

methodsThis Brief Practice Update was developed using the SVIN Standards and Parameters for Guideline Development in the classification of evidence and Class of Recommendation when evidence is available and Expert Opinion recommendation when evidence is lacking. The Guidelines and Practice Standards committee convened a multidisciplinary writing group to establish key clinical questions and develop a survey assessing Expert Opinion on the role of digital subtraction angiography in cerebral circulatory arrest determination. Survey items addressed technical considerations, interpretation criteria, and clinical integration. Iterative refinement was achieved through group consensus, and the final survey was distributed to a panel of experts in neurointervention and neurocritical care. The SVIN Guidelines and Practice Standards Quality Committee reviewed the findings for adherence to SVIN's internal evidence evaluation guidelines before submission to the SVIN board for societal endorsement.

resultsEvidence was evaluated by the writing group when available, and Expert Opinion was assessed using survey results. Suggested recommendations follow the established SVIN guideline framework for Class of Recommendation and Level of Evidence, with an Expert Opinion endorsement category for areas lacking high-quality evidence at the time of publication.

conclusionsThis update standardizes how to perform, interpret, and report digital subtraction angiography when used to assess cerebral circulatory arrest in brain death/death by neurological criteria evaluations, aiming to improve reproducibility across centers. It provides a structured framework to improve consistency and reliability among practitioners performing and interpreting cerebral angiography in this setting.