Learning objectives
To review the indications of diagnostic neuroangiography.
To explain a step-wise check list for appropriate preprocedural assessment,
technique of procedure and postprocedural care.
To review the angiographic intra cranial vascular anatomy with illustrative examples of common pathologies.
Background
Neuroangiography is an integral investigation in the management of patients with neuro- vascular diseases.
It is used for diagnosis,
but in many instances,
may be followed up with interventional treatment in the same sitting.
[1]
A sound understanding of the principles of appropriate periprocedural care and anatomy,
angiography technique and angiographic appearance of pathology are vital for the test to be diagnostic.
(I) Salient descriptors of normal neurovascular anatomy [1,
2]:
(A) Extra cranial carotid system (Figure 1):
· Common carotid artery
Left CCA form...
Findings and procedure details
(II) Indications [2]
Intra cranial
I.
Nontraumatic subarachnoid haemorrhage or SAH of unknown aetiology.
II.
Acute stroke
III.
Nontraumatic parenchymal cerebral haemorrhage
IV.
Intracranial aneurysm: To study cross flow/ complex aneurysm anatomy
V.
Cerebral vasospasm
VI.
Mass lesions: Preoperative tumour embolization,
eg.
meningioma,
cavernous sinus haemangioma.
VII.
Intracranial arteriovenous malformations to classify (Speltzer Martin score) and plan intervention
VIII.
Dural arterio-venous fistulas
IX.
WADA test
Extra cranial
I. Extracranial carotid stenosis
II. Carotid blowout
III. Subclavian steal
IV. Cervical trauma
V. Epistaxis
VI.
Preoperative tumour...
Conclusion
Diagnostic neuroangiography is an essential investigation used in the evaluation of neuro vascular diseases.
Basic knowledge of angiographic technique and image interpretation are important for radiology residents and our poster summarizes the must to know information on this topic.
References
[1] Thiex R,
Norbash AM,
Frerichs KU.
The safety of dedicated-team catheter-based diagnostic cerebral angiography in the era of advanced noninvasive imaging.
AJNR Am J Neuroradiol 2010; 31(2):230–234.
[2] Basic Neuroangiography: Review of Technique and Perioperative Patient Care; Sun Ho Ahn,
MD; Semin Intervent Radiol 2013;30:225–233.
[3] Citron SJ,
Wallace RC,
Lewis CA,
et al; Society of Interventional Radiology; American Society of Interventional and Therapeutic Neuroradiology; American Society of Neuroradiology.
Quality improvement guidelines for adult diagnostic neuroangiography.
Cooperative study between ASITN,
ASNR,
and SIR.
J...