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Cardiology
Carotid and Cerebral Angiography
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
9 sections · 87 slides
Overview
- Scope of this topic
- Advantages of catheter neuroangiography
Historical development
- Imaging the brain before angiography
- Egas Moniz and the origin of cerebral angiography
- First diagnostic applications
- Surgical carotid exposure era
- Engeset and the percutaneous technique
- Serial angiography and the three phases
- Seldinger technique and the femoral route
- Preshaped diagnostic catheters used in neuroangiography
- Adoption of transradial access
- Transradial versus transfemoral comparison
- Arterial access routes for neuroangiography
- Forearm and palmar arch anatomy on angiography
Indications for neuroangiography
- Why catheter study remains the reference standard
- Detection of small intracranial aneurysms
- Dissection, vasculopathy and steno-occlusive disease
- Idiopathic intracranial hypertension and venous sinus stenosis
- Arteriovenous shunting lesions and provocative testing
Contrast media
- Strontium bromide, the first agent
- Sodium iodide and its toxicity
- Thorotrast and delayed malignancy
- Modern iodinated agents
- Evolution of contrast agents
Radiation safety
- Radiation risk to patients and operators
- ALARA principle and patient selection
- Modern biplane angiography suite with ceiling and floor shields
- Personal protective equipment and monitoring
- Equipment settings that reduce dose
- Evidence for cranial protection
The neuroangiographic technique
- Preprocedural assessment
- Laboratory workup and antithrombotic management
- Contrast allergy premedication
- Positioning and sedation
- Landmarks for common femoral artery puncture
- Access practice at the authors' institution
- Reconstitution of a Simmons 2 catheter from the wrist
- Catheterisation of the vertebral arteries
- Left vertebral artery catheterisation from the right wrist
- Radial loop preventing catheter advancement
- Cervical and thoracic views and aortography
- Aortic arch injection showing the great vessel origins
- Cranial projections
- Injection parameters and phase acquisition
- Intraprocedural radiation practice
- Content of the procedure report
- Structuring the final impression
- Sequence of a diagnostic neuroangiogram
Pediatric and spinal angiography
- Pediatric neuroangiography in historical context
- Access and vascular risk in children
- Monitoring, sheath and anaesthesia in children
- Contrast limits in the pediatric population
- Radiation and haemostasis in children
- Indications and safety of spinal angiography
- Technique of spinal angiography
- Conditions for image quality and contrast burden
- Arteries that may supply the spinal cord
- Spinal dural arteriovenous fistula before and after embolisation
Complications
- Non-neurological complications
- Complication rates in diagnostic neuroangiography
- Neurological complications
- Contrast-induced encephalopathy
- Risk factors and management of contrast-induced encephalopathy
- Classification of complications
Future perspectives
- Middle meningeal artery embolisation
- Increasing attention to the venous phase
- Robotic diagnostic cerebral angiography
- Key points: technique and indications
- Key points: safety and complications
- References
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- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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