Normal Findings

Neuroangiography is used today, primarily as a diagnostic modality in the evaluation of patients with vascular diseases of the central nervous system. Typical four-vessel cerebral angiography includes selective catheterizations of both internal carotid and vertebral arteries with angiographic filming in the AP, lateral, or oblique planes as needed. Angiographic filming is acquired during the arterial, capillary, and venous phases, because each phase reveals important vascular information. For example, the arterial phase is critical in the evaluation of entities such as cerebral aneurysms, cervical or intracranial arterial stenosis, or arterial occlusions. In contrast, the capillary and venous phases may reveal important data regarding vascular malformations, tumor neovascularity, venous stenoses, or venous thrombi. The measurement of the intracranial transit time of contrast material may further provide insight regarding focal or diffuse central nervous system abnormalities. Therefore, all phases of the angiographic study can provide important information regarding the overall health of the central nervous system. Yet, angiography maintains flexibility in that studies may be tailored to answer specific clinical questions.

Risks of neuroangiography are generally related to the complexity of the angiographic procedure, with an estimated 1 percent overall incidence of neurological deficit and a 0.5 percent incidence of persistent deficit. y Risks include local bleeding or arterial injuries secondary to vascular access. The intraarterial positioning of an angiographic catheter within the arterial tree carries a risk of injury to the intimal lining of the arterial wall, particularly in patients with pre-existing atherosclerosis. This, coupled with the intra-arterial injection of contrast media, presents a risk of arterial dissection or stroke due to distal embolization. Lastly, there are potential risks associated with the use of iodinated contrast material, including allergic reactions and systemic organ effects such as renal damage. In preparing to study a patient with an allergic history, the

current recommendation is 50 mg of prednisone orally 13, 7, and 1 hour prior to the procedure. Diphenhydramine 50 mg orally may also be administered 1 hour prior to the procedure.

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