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Cerebral angiography is a form of angiography which provides images of blood vessels in and around the brain, thereby allowing detection of abnormalities such as arteriovenous malformations and aneurysms. The technique was pioneered by Egas Moniz in 1927.
Typically a catheter is inserted into a large artery (such as the femoral artery) and threaded through the circulatory system to the carotid artery, where a contrast agent is injected. A series of radiographs is taken as the contrast agent spreads through the brain's arterial system, then a second series as it reaches the venous system.
This is often the treatment choice if you've had several small strokes that can't be treated with medication. The surgeon inserts a small balloon into one of the blood vessels supplying the brain. The balloon enlarges the vessel and increases blood flow.
Cerebral angiography is done in the hospital or large radiology center. You will be asked to lie on an x-ray table. Your head is positioned and held still using a strap, tape, or sandbags, so you do not move during the procedure. The health care provider will attach electrocardiogram (ECG) leads to your arms and legs, which monitor your heart activity during the test.
Before the test starts, you will be given a mild sedative to help you relax.
An area of your body, usually the groin, is cleaned and numbed with a local numbing medicine (anesthetic). A thin, hollow tube called a catheter is placed through an artery and carefully moved up through the main blood vessels in the belly area and chest and into an artery in the neck. Moving x-ray images help the doctor position the catheter.
Once the catheter is in place, a special dye (contrast material) is injected into catheter. X-ray images are taken to see how the dye moves through the artery and blood vessels of the brain. The dye helps highlight any blockages in blood flow.
After the x-rays are taken, the needle and catheter are withdrawn. Pressure is immediately applied on the leg at the site of insertion for 10 - 15 minutes to stop the bleeding. After that time, the area is checked and a tight bandage is applied. Your leg should be kept straight for 12 hours after the procedure.
Digital subtraction angiography (DSI) uses a computer to "subtract" or take out the bones and tissues in the area viewed, so that only the blood vessels filled with the contrast dye are seen.
Although angioplasty with stent placement is theoretically applicable to the treatment of intracranial atherosclerosis, the safety and efficacy of this modality are controversial. In 2002. At that time, evaluation of this method was limited to several small retrospective series in which varying complication rates were demonstrated. Additionally, these studies largely focused on posterior circulation atherosclerosis and lacked data regarding stenosis of the anterior circulation, including the ICA. Recently, a handful of studies have emerged that allow for a more complete assessment of endovascular stent treatment and reveal developments in this rapidly changing field.
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