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Selective cerebral angiography is the main method for studying cerebral vessels. CT, MR and cerebral angiography of cerebral vessels - research process and price Cerebral vascular angiography

Cerebral angiography of cerebral vessels is a modern instrumental diagnostic procedure that allows you to literally see the required area of ​​the circulatory system. Before the scan is performed, a contrast agent is injected into the vessel being examined. With its help, all violations of the veins and arteries, if any, will be clearly visible on the x-ray.

Despite the fact that angiography of the head and neck vessels is a highly accurate procedure, it has its disadvantages and contraindications.

Angiography is a generalized name for all diagnostic measures, the purpose of which is to study blood vessels using the properties of X-rays. Therefore, using this method, you can obtain information about the condition of any part of the circulatory system. For example, coronary angiography is the same diagnostic method, but only in this situation the condition of the veins, arteries and vessels of the heart will be considered.

Diagnostic principle

Angiography of the vessels of the brain and neck is performed only with an X-ray contrast agent. It is injected directly into the vessel that needs to be examined. This method is called puncture. If it is technically impossible to perform such a manipulation, then contrast will be administered to the patient peripherally. As a rule, this is the femoral artery. A catheter is installed for the patient, which is advanced along the bed to the place that needs diagnosis. When the substance fills the vascular canal, the doctor takes a series of pictures. They are performed in lateral and direct projection.

The images obtained during such a study are interpreted by a radiologist or a leading physician.

If there are visible abnormalities, the patient will be prescribed appropriate treatment based on angiography and other tests.

Types of angiography

Depending on which part of the brain vessels needs to be examined, the patient may be prescribed:

  1. Survey cerebral angiography. Contrast is injected into the main artery that supplies blood to the brain. This type of diagnosis allows you to visualize all vessels.
  2. Selective. Contrast is injected locally into an artery that supplies blood to a small part of the brain.
  3. Super selective. During the diagnostic process, a smaller caliber vessel is examined in one of the blood pools.

Scientific progress has improved radiographic angiography. This was achieved thanks to computed tomography (CT) and magnetic resonance imaging (MRI). The information that can be obtained during the examination is more detailed, since the device takes a series of layer-by-layer images. The computer then processes the received information and produces an image in three-dimensional space. This advanced method is called multislice computed tomography (MSCT). Compared to conventional angiography, this diagnosis is considered safer for the patient.

Indications and contraindications

Due to the fact that angiography of the vessels of the neck and brain can have negative consequences for the patient, this examination procedure is prescribed only in cases of extreme necessity, when there is no other way to conduct the study.

Indications for this diagnosis may be:

  • suspicion of arteriovenous or arterial aneurysm of cerebral vessels;
  • determining the degree of vasoconstriction;
  • diagnosis of vascular blockage;
  • establishing a connection between the vessels and the tumor before the upcoming operation;
  • control of the location of clips that are installed on vessels, etc.

Patient complaints of headache, tinnitus, dizziness and other similar symptoms are not a reason for such a procedure.

The angiographic method is not completely safe for the patient, therefore there are a number of contraindications. Diagnostics is not recommended for the following reasons:

  • allergic reaction to contrast agent;
  • some neurological diseases;
  • mental disorders;
  • chronic or acute renal failure, which makes the normal process of removing the contrast agent from the body impossible;
  • myocardial infarction;
  • blood clotting disorder;
  • pregnancy and breastfeeding;
  • children under 2 years of age;
  • colds, flu and other pathologies that can provoke the development of complications.

Preparatory activities

After the doctor informs the patient what cerebral angiography is and also talks about the existing risks, it will be necessary to sign an agreement to conduct this study. Only after this does the preparation process begin.

In addition to a general blood test, urine test, etc., the patient must undergo an allergy test for a contrast agent.

If you cannot find a suitable drug, further preparation becomes pointless.

In order for the study to proceed without complications, the patient is advised to stop drinking alcohol. You must inform your doctor about all medications you are taking. Some medications will have to be abandoned, for example those that affect blood clotting.

It is forbidden to eat food 12 hours before the start of the study. At the time of diagnosis, the patient should not have any metal objects on him.

Research process

Before the puncture is made, the puncture site is treated with an antiseptic drug. To prevent the patient from experiencing discomfort, anesthesia is given, usually local. The patient must be connected to equipment that allows monitoring the heartbeat. After this, a puncture of the vessel is performed. If this is not possible, then a puncture of the carotid artery is performed. When inserting a catheter into the femoral artery, the patient first makes an incision in the skin. This allows you to make an accurate puncture the first time. The movement of the boat along the bloodstream does not cause pain. The direction of its movement is controlled using an X-ray machine. When the catheter reaches its target, the patient is injected with contrast. At this point, a feeling of heat, a metallic taste in the mouth and a rush of blood to the face may appear. These feelings won't last long.

When the contrast is introduced, a series of photographs begin to be taken, which are immediately developed. If necessary, the doctor may administer an additional dose of contrast agent to better visualize the condition of the veins. After all the necessary information has been collected, the catheter is removed from the vascular bed, and a sterile bandage is applied to the puncture site. After cerebral angiography, the patient should remain under medical supervision for 6-10 hours.

Multispiral angiography of the neck arteries and cerebral vessels (MSCT) differs from conventional angiography in that the radiation dose received by the patient is significantly lower and the quality of the images is better.

Possible complications

Regardless of what kind of puncture is made (cervical artery, femoral or specific vessel), the negative consequences can be as follows:

  • vomit;
  • drop in blood pressure;
  • redness and itching at the puncture site (allergic reaction);
  • heart rhythm disturbance;
  • spasm of cerebral vessels (can provoke acute cerebrovascular accident);
  • convulsions;
  • inflammation of the subcutaneous tissue if the contrast agent gets into the soft tissues;
  • bleeding at the puncture site;
  • anaphylactic shock.

To minimize the risk of complications after angiography, the patient is recommended to remain in bed for the first 2 days. Any physical activity is contraindicated. You should drink as much fluid as possible, but do not perform water procedures. You can remove the bandage from the puncture site only after the doctor’s permission.

The percentage of deaths from angiography of the vessels of the brain and neck is small, but it still exists. For this reason, you should be responsible when choosing a medical institution where this procedure will be performed.

Navigation

Angriography of cerebral vessels is a type of instrumental research method that allows you to assess the structural and functional state of large arteries. To perform this diagnostic procedure, a special radiopaque substance is used, the function of which is to detect areas of low patency of blood vessels.

Brain vessels with contrast agent

The MRI angiography technique is performed only if there are appropriate indications. The combination of a specialized contrast agent and X-rays allows you to obtain a reliable image of the blood vessels of the brain. Many patients undergo coronary angiography to evaluate the condition of the arteries supplying the heart.

Read more about using contrast media

Description of the method

The technique of CT angiography of vessels in the neck and head region has been known in medical practice for more than 100 years. This study is used in the diagnosis of diseases of the cardiovascular system.

Speaking about angiography, one cannot fail to mention that this method is valuable in diagnosing myocardial infarction, atherosclerotic changes in blood vessels, ischemic and hemorrhagic stroke.

Types of angriography

Cerebral angiography of cerebral vessels is divided into the following types:

  1. Catheterization. This technique involves the introduction of a radiopaque contrast agent through a pre-installed catheter in the femoral artery;
  2. Puncture. The necessary substance is administered through a puncture of one of the blood vessels.

Taking into account the area of ​​the area under study, the following types of angiography are distinguished:

  1. Super selective. In this case, we are talking about the study of a blood vessel, the caliber of which does not correspond to any blood basin;
  2. General angiography. This study visualizes cerebral vessels of any caliber;
  3. Selective angiography. During this medical diagnostic exercise, the condition of the vertebrobasilar or carotid system is assessed.

Superselective CT angiography of vessels in the neck and head area is used not only as one of the examination techniques, but also as a medicinal technique. If a person has a vascular problem, then medical specialists eliminate this problem during microsurgical intervention.

Indications for angriography

MRI angiography of the vascular area of ​​the neck and head is performed only in accordance with medical indications.

The main medical indications include:

  • Suspicion of arteriovenous malformation;
  • Suspicion of aneurysm formation;
  • In order to determine the severity of stenotic changes in cerebral vessels;
  • To control the location of surgical clips that were installed on the cerebral vessels.

The so-called CT angiography of cerebral vessels is not performed for those people who complain of periodic headaches, dizziness, general weakness and a feeling of tinnitus. This category of patients requires consultation with a neurologist, followed by laboratory tests.

Contraindications to angriography

This medical diagnostic technique has not only a number of indications, but a whole list of contraindications that do not allow its use as a research technique.

Such contraindications include:

  • Decrease or increase in blood coagulation parameters;
  • Individual intolerance to the components of the radiocontrast agent;
  • The period of pregnancy and breastfeeding. If necessary, such women undergo magnetic resonance angiography. Thanks to the use of a computed tomograph, it is possible to assess the state of cerebral circulation and the condition of the cervical spine;
  • The general serious condition of the patient caused by end-stage renal and liver failure, as well as decompensated heart failure of the 3rd degree;
  • Psychoneurological deviations that do not allow compliance with the necessary conditions of the medical diagnostic procedure;
  • Acute course of infectious and inflammatory diseases.

Preparing for the study

In order to obtain reliable research results, the following is recommended for each patient:

  • Stop drinking alcoholic beverages and smoking tobacco for 2 weeks;
  • Taking a biochemical and general clinical blood test, which will allow you to assess the general condition of the body and determine the patient’s Rh status;
  • Carrying out electrocardiographic examination;
  • Refusal to eat food for 8 hours before the intended study;
  • Refusal to use medications that affect the blood coagulation system;
  • Carrying out a skin allergy test with a radiopaque substance;
  • Local preparation of the area of ​​skin in which puncture and catheterization of the vessel will be carried out;
  • Removal of all metal products from the skin.

Methodology

The initial stage of angiographic examination of cerebral vessels is the signing of a voluntary consent to perform this study. Medical specialists install a peripheral vascular catheter, which allows access to the central circulatory system of a person.

The next stage is the so-called premedication. During this preparatory procedure, medical specialists administer tranquilizers, antihistamines, sedatives and painkillers. This stage is necessary to reduce the risk of negative complications.

During the next stage, the patient is placed on a special table and connected to a pulse oximeter and heart monitor. Next, medical specialists treat a separate area of ​​the skin with an antiseptic and inject an anesthetic. After this, the required blood vessel is punctured, through which access to the central arteries will be gained.

Results

During the procedure of angiographic examination of cerebral vessels, medical specialists have the opportunity to assess the structural and functional state of cerebral vessels, their elasticity, patency and anatomical condition.

In the presence of occlusive or stenotic changes, the x-ray image will show foci of blockage of the blood vessel, which impede the advancement of the radiocontrast agent. If pathological changes are detected, medical specialists submit for consideration the issue of surgical intervention to eliminate these lesions.

Complications

The likelihood of negative reactions from the body during angiography is equal to 0.4% of cases. The occurrence of such consequences is often associated with individual intolerance to the radiocontrast agent.

Today, medical specialists prefer to use iodine-containing radiopaque agents of the latest generation, which have minimal harmful effects on the human body.

  • In extremely rare cases, the following complications cannot be ruled out:
  • Convulsions;
  • Nausea and vomiting;
  • Local and systemic allergic reactions;
  • Penetration of radiocontrast substance into the epidermis;
  • Spasm of cerebral vessels;
  • General malaise;
  • Dizziness.

Along with MRI of the brain, this technique evaluates the vascular bed in the most detailed format.

Poor blood circulation in the brain is a common problem among people of all ages. Constant stress, poor environment, lack of a normal diet and other factors negatively affect the functioning of the cardiovascular system. Not only internal organs are affected, but also the neural network. Angiography of cerebral vessels will help recognize these problems. This medical study is needed to assess the condition of the arteries, vessels and veins of the brain. Next, we will look at what angiography is, how it is performed, when doctors resort to it, and what contraindications exist for it.

Angiography of cerebral vessels is a method of studying arteries, veins, and vessels, allowing one to detect places of blockage, narrowing, dilation, tumor processes, bleeding, and various diseases that are not detected by other means. To conduct the study, contrast is injected into the blood and fluoroscopy begins immediately. To perform cerebral angiography, X-ray angiography rooms are used. They are completely sterile and equipped with:

  • high-speed fluorography cameras;
  • multi-camera video recording devices;
  • angiographers.

More advanced medical centers use CT angiography equipment. It allows you to obtain clearer photographs of brain vessels and quickly decipher the data obtained. The duration of the procedure is 1 hour. After this, the patient is under the supervision of specialists for 8 hours. Even if there are no visible deviations after the examination, after a couple of days the patient should come for a routine examination.

When is angiography performed?

Perhaps this is the main question that concerns all patients. Angiography of cerebral vessels is prescribed only if the doctor suspects the presence of a tumor, blood clots, aneurysm, or hemorrhage. These processes manifest themselves:

  • dizziness;
  • constant migraine;
  • nausea;
  • pain in the neck;
  • loss of consciousness.

Cerebral angiography allows you to identify the location, degree and prevalence of disorders in the vessels, analyze the quality of blood circulation in the bypass vascular pathways, and the quality of the outflow of venous blood. Using this diagnosis, it is possible to prevent the development of acute circulatory disorders inside the brain and save patients from ischemia and hemorrhages.

Angiography of cerebral vessels is performed if there is a suspicion of local displacement of blood vessels or the presence of neoplasms in them. Using this diagnosis, tumors are detected in the area of ​​the sphenoid bone of the skull.

Benefits of angiography

Compared with magnetic resonance imaging, angiography of intracranial veins and intracranial arteries has the following advantages:

  • allows you to prevent unnecessary surgical intervention or serve as a signal for surgical treatment;
  • only this examination allows us to obtain a clear and clear picture of the structure of the blood vessels of the brain;
  • requires low doses of radiation that do not affect the patient’s health;
  • allows you to immediately begin treatment procedures to restore the lumens of blood vessels and veins when they are narrowed.

Contraindications to the procedure

MR angiography of the neck arteries and cerebral vessels, like other clinical research techniques, is not suitable for everyone. The list of contraindications for this procedure includes:

  • the presence of various mental disorders in the patient;
  • extensive swelling and cysts on blood vessels;
  • severe allergic reactions to contrast agents;
  • cardiac, renal, liver failure in acute condition;
  • the presence of metal implants;
  • pregnancy and lactation.

95% of people feel well after magnetic resonance angiography of blood vessels. However, 5% of patients may experience the following negative symptoms and complications:

  • allergic reactions resulting from the interaction of contrast and antiseptic;
  • severe hemorrhage/bleeding at the catheter insertion site;
  • myocardial infarction, stroke, sudden development of severe heart disease (less than 1%).

Therefore, before writing a referral to a patient, the doctor must take care to conduct all the necessary tests to exclude the sudden development of negative reactions.

What do angiography indicators mean?

The amount of radiation that will penetrate the veins and other brain tissue is determined by their density. It is expressed in various color shades. The bone in the image will be white, and the cerebrospinal fluid will practically not appear on the resulting images. Other brain substances have different colors and densities. Using them, doctors evaluate the internal structure. The doctor will provide a detailed transcript of the received images.

Features of preparation in cerebral angiography

Before MR angiography of the vessels of the brain and neck, it is necessary to do allergy tests with a contrast agent. Remember that the reaction does not always manifest itself externally in the form of itchy spots and redness. Some people, 10-15 minutes after interacting with the solution, feel dizziness, pain, and coughing attacks. If you notice such symptoms in yourself, then you should refuse to study intracranial arteries using angiography. In this case, the doctor will refer you for a magnetic resonance examination to rule out the use of contrast and the occurrence of associated complications.

The next step in preparing for angiography of the neck vessels will be taking tests. A general blood test, a general urinalysis are taken from the subject, and the Rh factor and blood type are determined. Biochemical and clinical blood examinations are also carried out. When preparing for cerebral angiography, you should avoid eating for 8 hours. The person being examined can continue to take the medications prescribed by the doctor, but the use of blood thinning drugs must be reported in advance. Before starting the procedure, you need to remove all metal objects near the area being examined. Removable dentures, pendants and pendants must remain in the room. Also, ordinary clothing is replaced with a special medical gown.

How is angiography performed?

Angiography of intracranial vessels begins with catheterization/puncture of the selected artery. This will be the vertebral or carotid artery. To study all the veins and vessels of the head, an aortic puncture is performed. An alternative to this method is catheterization. It includes the following steps:

  • the peripheral artery is punctured (ulnar, subclavian, femoral, brachial);
  • a catheter is inserted through the resulting hole and led to the mouth of the carotid/vertebral artery;
  • if you need to study the vessels of the neck and brain in detail, the catheter is inserted into the aortic arch.

The catheter is inserted under local anesthesia. The progress of the tube through the vessel is monitored using X-ray television. The vessel itself is not anesthetized, because its inner wall does not contain pain receptors. Once the catheter is brought to the desired point, a contrast agent is injected. It transmits X-rays poorly, so the accuracy of the results of such a study is slightly higher than that of a conventional MRI.

Important! When contrast is administered, you may feel a slight burning sensation, a metallic taste in your mouth, and a feeling of warmth. These are normal reactions and there is no need to worry. After 5-6 minutes they will pass.

As soon as the contrast is introduced, shooting of the head in three projections begins. The doctor evaluates the images instantly. If the magnetic resonance imaging with contrast is unclear, doctors inject additional substances and then remove the cervical and brain sections again. This procedure is carried out several times. The average duration of angiography is 60 minutes. During the entire procedure, doctors receive 20-30 images of the brain from different angles.

After the contrast has spread sufficiently throughout all tissues, a series of photographs are taken to determine the quality of blood flow through the veins. After this, the catheter must be removed. The subject must not move for 15 minutes. Doctors will stop the bleeding. The substance introduced into the vascular tract leaves the body after 24 hours through the kidneys.

The discovery of X-ray radiation gave impetus to the development of a revolutionary new stage in diagnostic medicine. Subsequently, the ability to assess the condition of internal organs in order to identify various diseases underwent a number of significant changes, the essence of which was to increase the accuracy of the results obtained and minimize the negative impact of ionizing radiation.

Angiography of cerebral vessels is the result of a combination of high-tech achievements with the capabilities of X-ray radiation, and allows us to identify a wide variety of pathological conditions of the brain caused by both diseases of the vascular system and other diseases directly or indirectly affecting changes in blood circulation.

General concepts

Getting a basic understanding of what angiography is is quite simple - just remember what an x-ray of any part of the body looks like. X-ray diagnostics is based on the complete or partial ability of the tissues of the human body to transmit ionizing radiation. The outlines obtained in the image make it possible to evaluate the structure of the organ without open intervention and diagnose the existing pathological condition.

The “transparency” of the human body to X-rays is the basis of cerebral angiography. When performing the latter, a radiopaque substance is injected into the vascular system, which makes it possible to obtain a clear image of the entire circulatory system from the main arteries and veins to the smallest vessels.

Vessels filled with a radiopaque substance become opaque to ionizing radiation, so they appear black in the image

The use of this method allows not only to visually assess the usefulness of all phases of cerebral circulation, to find the root cause of detected pathologies, but also, based on changes occurring in the blood supply system, to diagnose the presence of a neoplasm.

Important! Due to frequent cases of intolerance to iodine-containing drugs used as radiocontrast agents and significant ionizing load, angiography is performed only after a thorough examination by other diagnostic methods, excluding the possibility of other diseases causing similar symptoms.

Species

Depending on the method of introducing radiocontrast, angiography is divided into 2 types:

  • puncture;
  • catheterization

The puncture technique involves the introduction of a radiopaque substance into the main artery using a puncture needle, while the catheterization technique refers to the introduction of the above-mentioned substance directly into the examined vascular bed using a supply catheter.

The need to examine various parts of the brain determines the division of cerebral angiography into the following types:

  • carotid;
  • vertebral

Carotid angiography is used to study the condition of blood vessels in the cerebral hemispheres. Its essence lies in direct puncture of the carotid artery located in the neck or delivery of a contrast agent to the same area using a catheter through the femoral artery. Vertebral angiography is used to examine the posterior region of the brain (cranial fossa) and is performed by puncture or catheterization at various levels of the vertebral artery.

Also, cerebral angiography, depending on the technique of performing the study, is divided into:

  • for general - in this case, the study is carried out by introducing a contrast agent into the aorta to obtain a general overview of the state of the vascular system of the brain;
  • selective - total angiography, carried out by sequential catheterization of all vessels responsible for the blood supply to the brain;
  • superselective - with superselective angiography, a more detailed examination of all branches of the cerebral artery (anterior, middle and posterior) is performed; for this, contrast is administered by catheterizing all branches one by one.


X-ray machine for angiography

Methods

In addition to differences in the technique of performing cerebral angiography, there are also differences in the techniques used to visualize the vascular system. Modern medicine offers the following methods of performing angiography:

  • classical angiography;
  • angiography using a computed tomography scanner (CT angiography);
  • angiography using MRI (MR angiography).

Classic angiography

Until recently, the most common method of visualizing cerebral arteries. The essence of this technique is to inject a contrast agent into the main artery and then take a series of x-rays at short intervals of 1.5-2 seconds. As a rule, images are taken in several projections, which makes it possible to evaluate the different phases of blood flow and determine the presence and localization of pathology, if any.

CT angiography

A modern version of the classical technique, in which, after the introduction of contrast, layer-by-layer X-ray images are taken, followed by reconstruction of the volumetric image using computer data processing. Since CT angiography does not require puncture of the arteries, since the contrast agent is administered intravenously, this significantly reduces the likelihood of negative consequences of surgery (puncture) and x-ray load on the body (ionizing radiation). The vessels, in this case, have particularly clear visualization, due to which the information content of CT angiography is several times higher than standard angiography.

Important! The most complete information about the state of cerebral vessels is obtained using the MSCT method (multispiral computed tomography), carried out using the latest generation computed tomography equipment.

In terms of information content, magnetic resonance angiography is equivalent to CT diagnostics, however, the ability of the MR tomograph to visualize soft tissues and the absence of radiation exposure to the patient’s body makes it possible to diagnose even minor changes in the vascular structures of the brain in patients with contraindications to radiation exposure, for example, in pregnant women women. The procedure is performed with an MRI scanner switched to angiographic mode.

The main contraindication to MR angiography is the presence of metal objects (grafts) in the body:

  • pacemaker;
  • joint implants;
  • steel plates in the skull;
  • electronic hearing implant.

A relative disadvantage of this technique is the duration of the procedure - it takes 30–40 minutes to complete. During this time, the patient must remain completely still.


An image taken on an MRI scanner without the introduction of a contrast agent

Indications

Indications for cerebral angiography are pathological conditions that cause disturbances in the functioning of the brain. Hemorrhagic circulatory disorders:

  • aneurysms;
  • diverticulum;
  • angioma.

Ischemic circulatory disorders:

  • cerebral atherosclerosis;
  • blood clots;
  • arterial deformation.

Tumors leading to changes in the vascular pattern, as well as the lack of results after other methods for diagnosing brain diseases in the presence of the following symptoms:

  • constant dizziness not related to blood pressure;
  • epileptic seizures;
  • confusion of consciousness;
  • increased intracranial pressure;
  • previous stroke or suspected micro-stroke;
  • intracranial hematomas caused by head trauma;
  • chronic headache of unknown origin;
  • nausea accompanied by dizziness and headaches;
  • tinnitus.

It is also advisable to perform cerebral angiography to plan upcoming surgery and to monitor the patient’s recovery after brain surgery.


On the left, the angiographic image shows an aneurysm, on the right, deformation of the artery

Preparation

Preparation for cerebral angiography includes a number of activities:

  • obtaining written consent from the patient for diagnostics;
  • warning about refusal to eat 12–14 hours before the upcoming procedure;
  • administering tranquilizers or sedatives to the patient when they show anxiety;
  • hair removal in the puncture area if the puncture is performed in the groin fold;
  • Before starting the procedure, a test is performed to determine the patient's sensitivity to the radiocontrast agent.

To carry out the latter, a small amount of the drug is injected subcutaneously, and the appearance of any reactions is observed for some time. If increased sensitivity to contrast occurs, the procedure is canceled and replaced with MR angiography. Immediately before the procedure (10–20 minutes), the patient is administered No-shpa, Atropine and Suprastin or another antihistamine to reduce sensitivity to the injected substance and minimize the risk of an allergic reaction.

The future puncture site is treated with a disinfecting solution and injected with a local anesthetic (Novocaine). If the patient experiences increased agitation or epileptic seizures, general anesthesia is used.

Important! Due to the fact that the substances used to contrast blood vessels have an extremely negative effect on the liver and kidneys, 10 days before angiography it is not recommended to drink alcohol, which impedes the functioning of these organs.


MR angiography may require you to remain still for a long time.

Carrying out

In order to puncture the carotid artery, the doctor palpates the pulsation area and fixes the artery with his fingers. Next, the artery is punctured with a puncture needle at an angle of 60-70°. To facilitate the process, a small incision can first be made in the puncture area. The needle is connected to a syringe pre-filled with a radiopaque substance (Urografin, Verografin).

If the patient is conscious, he is warned about the administration of the drug, as various side effects may occur:

  • nausea;
  • pain in the head or chest;
  • heat in the extremities;
  • heartbeat;
  • dizziness.

To fill the cavity of the carotid artery, about 10 ml of contrast is required. The duration of administration should not be more than 2 seconds, since with prolonged administration the concentration of the substance in the vascular bed will decrease.

Next, 4–5 images are taken in different projections, simultaneously trying to capture the image of the vessels in all phases of blood flow. To do this, the time interval of the images is calculated based on the speed of blood flow. At the end of the procedure, the needle is removed, and the puncture site is pressed with a gauze swab for 10–20 minutes, and then a small weight is placed for 2 hours.


Arterial puncture during general angiography

Contraindications

Angiography of cerebral vessels has virtually no contraindications; however, there are a number of limitations when the use of this diagnostic procedure carries certain risks. In this case, the decision on the advisability of using this method is made by the doctor. Taking into account the possible negative impact on the body, the use of angiography has the following limitations:

  • an allergic reaction to iodine-containing substances used in diagnosis that cannot be controlled with antihistamines;
  • severe mental disorders in the acute stage;
  • acute renal failure, which causes retention of the contrast agent in the body;
  • myocardial infarction;
  • chronic liver diseases in the stage of decompensation;
  • pregnancy is a contraindication, since the contrast agent and x-ray radiation have a double negative effect on the fetus;
  • impaired blood clotting function threatens bleeding at the puncture site;
  • written refusal of the patient to undergo angiography.

Important! In the event of an emergency condition that threatens the patient's life, which requires immediate diagnosis, the decision to use angiography is made based on a comparison of the likelihood of developing negative consequences.

Complications

Despite its relative safety, cerebral angiography can have the following negative consequences:

  • anaphylactic shock due to an allergic reaction to the administration of an iodine-containing substance;
  • inflammation or necrosis of the tissues surrounding the vessel due to contrast getting there (extravasation);
  • acute renal failure.

Allergy is the main and most common problem during angiography. Since an allergic reaction to iodine substances is characterized by a sudden and rapidly developing course, it may have the following manifestations:

  • edema;
  • hyperemia (redness);
  • itching;
  • hypotension (low blood pressure);
  • weakness and loss of consciousness.

The use of modern non-ionic radiopaque agents can significantly reduce the risk of developing anaphylactic shock.


Omnipaque solution belongs to a new generation of radiopaque agents that do not cause allergies.

Extravasation is usually a consequence of improper technique for puncturing the arterial wall. In this case, the artery is punctured through, and the contrast penetrates into the soft tissue surrounding the artery, causing inflammation and, in rare cases, necrosis.

Acute renal failure occurs in cases of pre-existing dysfunction of the renal apparatus. Since the removal of contrast from the body is carried out primarily by the kidneys, they are subject to intense negative effects, which results in ischemia of the parenchyma and progression of renal dysfunction. Diagnosis of the functional state of the urinary system is a mandatory measure carried out before angiography. To speed up the removal of the contrast agent from the body and reduce the load on the kidneys, after diagnosis, the patient is advised to drink plenty of fluids.

Despite the fact that angiography of cerebral vessels is not, in the usual sense, a surgical intervention, it is a rather complex invasive procedure that involves a serious burden on the body. In this regard, the patient, after diagnosis, should be under the supervision of a doctor to prevent the development of complications. In this case, systematic temperature measurement and inspection of the puncture site should be included in the mandatory list of postoperative measures.

23.08.2017

Cerebral angiography is an X-ray examination of the vessels of the head using a contrast agent. Diagnostics allows you to see the phases of capillary, arterial and venous circulation, vascular pathologies and their exact location, and detect a brain tumor. The essence of the procedure is catheterization or puncture of the vessels of the head and neck, injection of a contrast agent and taking pictures.

Blood circulation in the brain is maintained by two main pools - the carotid (cervical artery) and the vertebrobasilar (vertebral artery). Based on anatomical features, cerebral angiography is performed through contrasting one of the two listed arteries, most often the carotid artery.

The radiocontrast agent for the procedure is one of the drugs containing iodine: Gipak, Verografin, Urografin, Cardiotrast, Triombrast, etc. All of the above drugs are water-soluble and are administered parenterally. In some patients, drugs can cause an allergic reaction and negatively affect the kidneys if the organ's functions are reduced.

Types of angiography of cerebral vessels

Angiography allows you to see the phases of capillary, arterial and venous circulation

Given the variety of methods of implementation, angiography of neck vessels differs by type:

  • according to the method of introducing the contrast agent - puncture (introduced into the vessel through a needle) and catheterization (introduced through a catheter);
  • at the site of contrasting vessels - general (a catheter with contrast is brought to the abdominal or thoracic aorta), selective angiography of the vessels of the neck (contrast is introduced by puncture or catheter into a cerebral blood vessel) and superselective (a catheter with contrast is brought to the auxiliary branches of the main cerebral arteries);
  • According to the visualization method, angiography of cerebral vessels can be classic (a series of X-ray images after contrast is injected), MR angiography (vessels are examined on MRI without contrast, although if necessary, the information content of the technique can be increased by introducing a contrast agent) and CT angiography (a series of images on CT after contrast injection, then a three-dimensional picture of the vascular bed is simulated).

Each of the listed types of vascular angiography is characterized by advantages and disadvantages. A specialist can choose one of the diagnostic methods after forming indications for a particular patient.

When is angiography prescribed?

Angiography of cerebral vessels is prescribed to identify possible pathologies

Angiography is prescribed to identify possible vascular pathologies in the brain and diseases of brain tissue. Angiography of the vessels of the brain and neck is prescribed for the following conditions:

  • embolism/thrombosis of cerebral arteries;
  • cerebral atherosclerosis or stenosis (narrowing of the lumen of blood vessels due to atherosclerotic deposits on their walls);
  • vascular aneurysms, congenital and acquired brain diseases;
  • chronic dizziness;
  • chronic headache of unknown etiology;
  • epilepsy;
  • nausea is accompanied by dizziness and headache;
  • frequent fainting;
  • suspicion of a neoplasm;
  • chronic increase in intracranial pressure;
  • complaints of ringing and noise in the head;
  • history of microstroke/stroke;
  • for diagnosing brain failure;
  • intracranial hemorrhage/hematoma;
  • focal neurological symptoms.

Cerebral angiography of cerebral vessels is a valuable diagnostic procedure not only for making a diagnosis, but also for the purpose of planning surgery. The neurosurgeon can create a three-dimensional model of the tumor in advance and foresee the stages of future surgery, which minimizes the risk of complications during surgery.

Preparation for angiography

Before the procedure, the patient must undergo examination and tests.

Before performing the procedure, the doctor tells the patient what angiography is and how to prepare for the study. The first step is to test for sensitivity to iodine. During the test, 2 ml of contrast agent is injected intravenously, then the doctor monitors the patient's condition for several hours.

If choking, coughing, redness of the skin or rash, swelling, headache and other signs of intoxication appear, the patient should not be diagnosed with a contrast agent containing iodine. In such situations, MR angiography is recommended.

Considering that angiography of the neck arteries is an invasive diagnostic method, since the integrity of the vessels is compromised, a number of studies are prescribed before the procedure:

  • diagnostics of kidney functions;
  • urine and blood analysis;
  • blood clotting test;
  • consultation with an anesthesiologist, therapist;
  • fluorography.

Be sure to determine the blood type and Rh factor so that in case of bleeding, blood components can be transfused.

If the patient is taking any medications, it is usually not necessary to stop taking them before the procedure, with the exception of blood thinners, as they may cause bleeding.

Approximately 10 hours before the angiography you should no longer eat, and 4 hours before the procedure you should not drink. When preparing directly for the procedure, the patient removes all metal jewelry so that it does not distort the information in the image. If excessive anxiety occurs, the patient may be given a sedative injection.

Classic angiography is rarely used because new MRI and CT scans are safer and more informative

This method is the very first of all invented; it was used long before the discovery of MRI and CT. Today, the classical method is rarely used, since new techniques are safer and more informative. The essence of the procedure is reduced to puncture of the carotid artery (the affected area is first anesthetized), then 10-12 ml of contrast heated to body temperature is injected.

What follows is a series of x-ray images. Images are taken in 2 projections every 1-2 seconds in order to gradually evaluate all phases of blood flow and detect the type and location of pathology (if any). Contraindications to classical angiography include allergies to iodine, mental disorders, severe cerebral atherosclerosis, coma, pregnancy, hypertension, end-stage renal failure, and childhood.

CT scan takes three-dimensional pictures

This method represents a relatively new study of cerebral vessels. The essence of the procedure comes down to intravenous administration of contrast, after which tomography is performed on a computer (layer-by-layer X-ray images of the brain are taken), then the images are collected into three-dimensional pictures, where the vessels are clearly visible. Significant advantages of CT:

  • there are no risks associated with surgery, as with classical angiography;
  • X-ray load is reduced;
  • the results are much more informative than with the classical method. The most informative will be SCT angiography, which uses the most modern spiral computed tomographs.

The following conditions are contraindications to the study of cerebral vessels using CT angiography:

  • iodine intolerance;
  • end-stage renal failure;
  • pregnancy and breastfeeding;
  • diabetes mellitus in decompensated form;
  • thyroid pathology;
  • coma;
  • obesity (the tomograph is designed for patients weighing up to 200 kg).

Preparing a patient for CT angiography comes down to the same principles as described in the classic study.

Most often, an MRI is prescribed for examination.

This procedure is performed using a magnetic resonance imaging scanner. The equipment uses a magnetic field rather than X-rays to visualize internal organs. This means that during an MRI the human body is not exposed to x-ray radiation, which can definitely be attributed to the advantages of the technique.

Another advantage of the procedure, which strikingly distinguishes it from the previous two methods, is the possibility of performing it with or without a contrast agent. Everything will depend on the goals of the study. The technique is used as the only method for patients for whom contrast is contraindicated.

The following situations are contraindications to MR angiography:

  • presence of an implanted heart pacemaker;
  • claustrophobia;
  • obesity (the device is designed for a certain maximum body weight);
  • mental disorder;
  • pregnancy (due to the fact that no studies have been conducted on the influence of the magnetic field on the fetus);
  • the presence of metal implants (artificial joints, hemostatic clips, metal plates, etc.).

The disadvantages of the procedure include the duration of the procedure - the patient will need to lie motionless in the capsule for 20-40 minutes.

Is cerebral angiography dangerous?

Complications may be associated with impaired renal function

There are three types of complications that can arise from angiography of cerebral vessels. The first option is an allergic reaction to iodine. The complication is quite serious, but the number of incidents has decreased due to safe contrast agents.

Iodine gives an immediate or anaphylactic reaction - itching, swelling and redness in the place where the substance was injected, then weakness, shortness of breath begins, pressure drops and anaphylactic shock begins. All medical rooms where contrast is administered are necessarily equipped with medications that will help provide emergency care to the patient in case of an allergic reaction.

The second possible complication is contrast extravasation. It occurs if the contrast agent, instead of a venous vessel, gets into the soft tissue around it. The reason is the incorrect technique of puncturing the vein or when the wall of the vessel could not withstand the pressure with which the contrast is introduced into the bloodstream. If up to 10 ml of the substance leaks out, there will be no serious complications, but if more, the fatty tissue will become inflamed, and tissue necrosis at the injection site is possible.

The third variant of complications is acute kidney failure. The reason is that the contrast agent is excreted by the kidneys. If there is a history of chronic renal failure, then a large volume of contrast will cause oxygen deficiency in the renal cortex, accelerating the dysfunction of the organ, up to acute failure and the need for dialysis. To prevent such developments, before angiography, the physician evaluates the functioning of the patient’s urinary system.

Summarizing the above, it can be noted that, although there are some shortcomings, angiography remains a good option for diagnosing cerebral vascular pathologies.