Cerebral Angiography Jessica Birt CIT Noah’s Ark----- 

Introduction Angiography: study of blood vessels, by the use of contrast to make the vessels visible under fluoroscopic procedures. Cerebral angiography: specifically looking at the vessels of the brain –Done to detect abnormalities, blockages, or for therapeutic reasons

Indications Narrowing or blockage Acute stroke Therapeutic reasons “Map” of the brain prior to neurosurgery Bleeding within the skull Inflammation Bulges in arterial walls/ Aneurysms Blood clots in the brain Intracerebral hemorrhage Arteriovenous & fistulae malformations Highly vascular extra- and intra cranial tumors

Bleeding Brain

Cerebral Aneurysm

Risks Internal bleeding and hemorrhage – Involves puncturing an artery Stroke or heart attack –Blood clots or plaque dislodge forming a blockage Allergic reaction –To contrast

Contraindications –Pregnancy

–Coagulation ability –Kidney disease

Anatomy Major vessels involved in cerebral angiography include: –Carotid arteries: supply blood to the anterior and middle portions of the brain –Vertebral arteries: supply blood to the posterior portions of the brain –Jugular veins: venous drainage of the brain –Femoral artery: accessed site for arterial puncture

Preprocedural Care and Cautions Review patients medical history and lab resultsReview patients medical history and lab results This will give the physician a better understanding of the condition of the patientThis will give the physician a better understanding of the condition of the patient Establish and understandingEstablish and understanding Patient needs to know what to expect, risks, complications etc.Patient needs to know what to expect, risks, complications etc. Must have permission in the form of written informed consentMust have permission in the form of written informed consent

Equipment –Image intensifier fluoroscopic unit –Angiographic table with movable or free- floating top –Rapid sequence film changers –Electromechanical contrast injector –Digital subtraction capabilities –Sterile tray set up with all the appropriate tools for a cerebral angiogram –Guidewires: based on personal preference –Catheters: based on personal preference/single end hold w/no side holes

Contrast Past: used ionic iodinated contrastPast: used ionic iodinated contrast Today: use nonionic iodinated contrastToday: use nonionic iodinated contrast –Iohexol, iopamidol, ioversal, imagopaque Amount injected depends on condition, age, weight and pathology of vessels

Procedure Details Local anesthetic at puncture site Small incision over the femoral artery Needle placed into vessel using Seldinger Technique Guidewire placement Catheter placement Contrast injected

Common Filming Positions Carotid Arteries: anteroposterior axial lateralCarotid Arteries: anteroposterior axial lateral anteroposterior oblique Vertebral Arteries:Vertebral Arteries: anteroposterior axial lateral

Lateral Views of Carotid Arteries

Digital Subtraction Useful for vessels that cannot be seen due to bony structure overlapping.Useful for vessels that cannot be seen due to bony structure overlapping. Arterial, capillary, venous phase subtraction films are routine in cerebral angiography.Arterial, capillary, venous phase subtraction films are routine in cerebral angiography. Small lesions, that are virtually undetectable on routine films are often clearly visible.Small lesions, that are virtually undetectable on routine films are often clearly visible.

Conclusion Conclusion No longer primary means of diagnosing pathological conditions of the cerebrovascular circulatory systemNo longer primary means of diagnosing pathological conditions of the cerebrovascular circulatory system Its use in conjunction with neurovascular interventional studies has not diminishedIts use in conjunction with neurovascular interventional studies has not diminished Still a very effective tool in diagnosing cerebral blood vessels because it determines the extent of vascular involvement of a problemStill a very effective tool in diagnosing cerebral blood vessels because it determines the extent of vascular involvement of a problem Can be risky, but its accuracy and benefits usually outweigh the risks making it a valuabletoolCan be risky, but its accuracy and benefits usually outweigh the risks making it a valuable tool