Home Wisdom teeth Cerebral angiography is a current method for diagnosing cerebral vessels. Conducting angiography of cerebral vessels Selective angiography of cerebral vessels

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Cerebral angiography is a current method for diagnosing cerebral vessels. Conducting angiography of cerebral vessels Selective angiography of cerebral vessels

Shoshina Vera Nikolaevna

Therapist, education: Northern medical University. Work experience 10 years.

Articles written

In modern medicine, there are many techniques that allow you to examine the condition in detail. vascular system brain, one of them is cerebral angiography.

Many patients who are prescribed this type examination, are interested in the following questions: what is angiography of cerebral vessels, how the procedure is performed, who is indicated for it, how accurate the examination results are. More on this below.

More about the method

Cerebral angiography(examination) of cerebral vessels refers to instrumental methods brain research. With this procedure, a specialist can see the condition of the veins and arteries in the patient's brain, and this is not a figurative expression. During the procedure, the patient is injected with a contrast agent directly into the vascular system, and with the help of images taken by an X-ray machine, the specialist receives a clear picture of the state of the brain vessels filled with contrast.

Angiography (examination) of cerebral vessels is considered standard procedure, used for a comprehensive study of the vascular system, veins and arteries located in the patient’s head. Based on the results of the examination, the specialist can determine the following:

where it happened
what is the condition of the vessels (are they narrowed or dilated),
presence and location,
identify tumors and neoplasms,
detect bleeding or blood clot in brain tissue,
hold the vascular system before planned operation on the brain.

But, like any examination performed using X-rays, angiography cannot be considered completely safe. This method has a number of limitations and contraindications.

Medicine has been familiar with angiography of cerebral vessels for more than 90 years, in Russian medicine The technique began to be used in the fifties of the last century. The great information content, accessibility and simplicity of the method quickly brought it popularity. Currently, the improved examination continues to be used everywhere.

Modern types of examination

In modern medicine, several types of examinations are carried out, generally called “angiography”. There are:

According to the method of contrast administration:

Puncture examination. Contrast is injected into a specific vessel through a puncture needle.
Catheterization examination. Connecting a catheter with contrast near vascular bed.

According to the location of the examined vessels:

General angiography. The contrast agent is injected through a catheter into the aorta (thoracic, abdominal) for full examination all vessels.
Selective angiography. Contrast is injected into a specific vessel using a catheter or puncture needle.

By visualization method:

angiography of the vessels of the brain and neck - the patient’s vascular system is examined using a tomograph.

Computed tomography using X-rays allows you to obtain slices of images of blood vessels and brain matter. The information received is subjected to computer processing, as a result the specialist receives three-dimensional images of the examined areas. How is a tomography done? During the procedure, contrast is injected into the patient's vein located in the forearm. The procedure is painless and does not require hospitalization or hospital stay.

angiography - the condition of the patient’s blood vessels is examined on a modern spiral tomograph, introducing a large amount of contrast into the abdominal aorta.

MSCT of cerebral vessels is considered a safer procedure than CT. The examination has virtually no effect harmful influence on the patient’s body, despite the fact that during the procedure contrast is also introduced to study the vascular system of the brain. The harmlessness of the method lies in the fact that the modern tomograph in which the patient is placed does not emit X-rays.

angiography of cerebral vessels - examination of the vascular system is carried out using a magnetic resonance imaging scanner.

In modern medicine, MR angiography of vessels is recognized as the most advanced and informative examination technique. The magnetic resonance method is considered the most harmless for the patient. What does vascular MRI show? Used in magnetic resonance imaging electromagnetic waves allow you to obtain complete data on the state of the vascular system and brain tissue, detect hematomas and neoplasms. MRI with angiography is performed without the introduction of contrast, which is why such an examination is indicated for allergy sufferers.

MRA (examination) of cerebral vessels makes it possible to study the entire vascular system without resorting to x-rays. The absence of radiation not only makes the study safe, but also allows it to be carried out as many times as necessary to make a diagnosis.

MRI of the brain is prescribed in the following cases:

In the presence of .
For periodic headaches, in the ears, frequent dizziness, visual impairments.
If a developing tumor is suspected.
At .
At pathological changes in blood vessels and brain tissue.
For control after brain surgery.

Magnetic resonance angiography of blood vessels also has some contraindications. It is not recommended:

people suffering from claustrophobia;
patients with chronic renal failure;
women on early stages pregnancy;
patients with pacemakers, metal implants in the body.

All options for angiographic examination, carried out in one way or another, have a number of advantages and disadvantages. A specific method of examination is assigned by a specialist to each patient personally.

Who is indicated for the examination?

The procedure is prescribed to patients to confirm or refute the following diagnoses:

Presence of an aneurysm.
Atherosclerosis.
Thrombosis of blood vessels of the head.
Damage to the skull with suspected internal trauma.
Tumors in brain tissue.
Presence of malformation.

Like any study, angiography has a number of contraindications for which it is not recommended:

Allergic reactions to a contrast agent containing iodine.
Mental disorders.
The presence of an infectious disease or inflammatory process in the body at the time of the procedure.
Thrombophlebitis.

After the examination, the patient (in rare cases, no more than 5 percent of the total number of subjects examined) may develop the following complications:

allergic reactions for contrast, not detected by the test;
the appearance of bleeding in the area where the catheter is installed;
the development of diseases such as: acute renal failure, heart failure.

How is the examination carried out?

If the patient is prescribed general angiography, then this examination is carried out as follows:

The patient has a needle or catheter inserted into the desired vessel.
Through it, a radiopaque iodine-containing drug that does not transmit x-rays well is injected into the selected artery.
The specialist takes several pictures of parts of the brain (in frontal and lateral projection).
After the contrast agent enters the veins from the arteries, the shooting is repeated.
The catheter is removed from the patient and the procedure is completed.
The duration of the procedure is from 30 to 60 minutes, mandatory monitoring of the patient’s condition for several hours.

When iodine-containing contrast enters the vascular system, many patients complain of hot flashes, a burning sensation in the head and neck, and a metallic taste. These sensations disappear without a trace after a while.

If the patient is prescribed multispiral angiography or CT, the examination is carried out using a tomograph. The patient does not need to stay in the hospital before and after the procedure, since more modern views examinations are less traumatic for the body.

With MRI angiography, no contrast enters the patient’s body, therefore, the risk of allergic reactions to iodine is completely eliminated. The procedure does not require any special preparation, and there is no recovery period after its completion.

How to prepare for the examination

The patient scheduled for the procedure must prepare for it. The preparation includes the following:

conducting a sensitivity test (if the examination is carried out using contrast). Before starting the procedure, the specialist administers a small dose of the substance to the patient and observes the body’s reaction; the test must be done about an hour before the procedure. If unwanted symptoms occur: skin rash, itching, severe headaches, nausea, the patient is prescribed another type of study;
The study is recommended to be carried out on an empty stomach, therefore, the patient should refrain from eating several hours before the procedure;
Before the examination, the patient must remove any items containing metal: earrings, rings, chains, hairpins.

Why is it worth doing angiography?

In modern medicine, this type of examination is considered the most advanced method. It allows you to carry out full diagnostics the state of the vascular system of the brain, which shows its importance for identifying pre-existing diseases. Also, with the help of the study, it is possible to identify the disease at its very beginning and begin treatment in a timely manner, which will not only reduce the risk of complications, but will also allow the patient to be completely cured.

The vast majority of people who undergo the procedure do not feel any discomfort; only a small percentage of patients experience complications after the examination.

The low cost of the procedure is also an additional advantage.

Cerebral angiography is a minimally invasive method for studying the condition of the arteries of the head and brain, which is the “gold standard” in identifying their damage. A similar method is used to diagnose the atherosclerotic process, thrombotic and embolic conditions, congenital disorders of the structure of blood vessels, etc. The study is carried out in accordance with the existing indications and contraindications, which makes it possible to achieve a high level of safety and information content during cerebral angiography of cerebral vessels.

About the procedure

Cerebral angiography is a study of the blood vessels of the brain carried out to check their condition

Angiography of cerebral vessels – modern method diagnostics that allows you to visualize the arteries of the brain, identifying abnormalities in their structure, for example:

various types of narrowings and aneurysms;
atherosclerotic lesion;
thrombotic masses or any other emboli;
arterial rupture sites;
tumor formations, etc.

Selective cerebral angiography is performed with the simultaneous injection of a contrast agent into the arterial bed, which makes it possible to highlight the vessels in the resulting image. To visualize the brain and skull, classical types of radiography can be used, as well as computed tomography or magnetic resonance imaging (CT or MRI, respectively). Iodine preparations are most often used as contrast agents, which are highly safe for patients.

The purpose of the procedure should always be based on identifying the person’s indications and contraindications for the examination.

Selective angiography differs from standard angiography in that the contrast agent is initially injected into a small vessel, allowing for better information with less impact on the body.

Indications and contraindications

When using cerebral angiography, it is very important to determine the patient’s indications and contraindications for an angiogram. Indications include the following conditions:

atherosclerotic damage to the vascular bed of the brain and stenosis of the arteries of any other cause;

Normal artery and narrowing of the lumen of the vessel in atherosclerosis

blood supply disorders associated with blood clots or emboli;
dilation of arteries, as well as congenital disorders of their structure;
high level intracranial pressure;
hemorrhagic damage to the structures of the central nervous system;
suspicion of a tumor lesion of the brain;
epilepsy;
post-stroke conditions, etc.

In all these cases, when prescribing conventional or selective angiography, the doctor must also evaluate the patient’s contraindications. Otherwise, various complications of the procedure may develop. Contraindications include:

individual intolerance or allergic reactions to iodine preparations used as radiocontrast agents;
acute disturbances in the functioning of internal organs;
chronic kidney damage;
pathological changes in the hemostatic system, due to the risk of thrombosis or hemorrhage;
period of pregnancy and natural feeding.

Pregnancy is one of the contraindications to angiography

Any contraindication is a direct prohibition on carrying out this diagnostic method.

If any contraindications are identified, the study must be abandoned, choosing another method of visualizing cerebral vessels.

Types of research

Selective angiography is the “gold standard” in identifying lesions of the cerebral arteries. In this case, there are several types of the procedure, differing in the location of the injection of the radiocontrast agent:

with general angiography, X-ray contrast is injected into the aorta or common carotid artery, which allows visualization of all the vessels of the head;
a selective type of study involves the introduction of a radiopaque substance into the arteries of the brain, which allows for minimal effects on other vessels of the body;
with a superselective approach, only small branches of the cerebral arteries are contrasted.

In addition to differences in contrast approaches, procedures may differ in the imaging method used:

The classic approach is to use standard radiography in several projections. This allows for non-volume images of the brain with the cerebral arteries highlighted. As a rule, this approach in modern medicine is used when the following types of procedures are unavailable;
angiography using computed tomography allows you to obtain a three-dimensional image of the vascular bed. In this regard, the doctor can easily identify structural disorders and make an accurate diagnosis. Main advantage this method– small time costs while maintaining a high level of visualization;

Aneurysm discovered during CT angiography of cerebral vessels

Magnetic resonance imaging with or without arterial contrast allows for a high degree of detail in the vascular pattern, which makes it possible to detect even minor abnormalities in the structure of the arteries. It is important to note that this angiography method takes significantly longer than those described above.

The choice of a specific type of study depends on the attending physician. It is he who assesses the patient’s condition, existing indications and contraindications, determining the necessary approach to diagnosing the disease.

What should the patient do?

Before talking about how the study is carried out and what it is, cerebral angiography of cerebral vessels, it is necessary to consider the issue of proper preparation patient for examination. The attending physician must provide the following preparatory steps:

Carrying out diagnostic examination, which includes a general and biochemical blood test, fluorographic examination of the lungs, electrocardiography, analysis of the blood coagulation system.
Consultation with a doctor general practice and an anesthesiologist.
Carrying out a test for sensitivity to iodine-containing medications. This test is carried out by intravenous administration 1 ml of contrast agent, followed by assessment of the patient’s condition and identification of clinical symptoms allergic reaction.
Conversation with the patient about the upcoming study.

A doctor talks with a patient about angiography

The attending physician should discuss the nuances with the patient before performing an angiography this study, and also explain to him the necessary actions after the procedure.

In addition to the doctor’s actions, the patient is recommended to follow the following tips:

the last meal should be taken no later than 10-12 hours before the study;
During the procedure, it is necessary to remove various earrings, rings, dentures, etc.

Conducting a survey

Selective angiography of cerebral vessels is performed in an operating room using a special angiograph. At the first stage, the patient's femoral or carotid artery is catheterized, through which a special probe is inserted into the lumen of the vessel, which is necessary to supply a contrast agent.

Carrying out arterial catheterization

The gradual introduction of a radiocontrast agent with simultaneous computer or magnetic resonance imaging allows one to obtain images of the arteries of the brain and identify pathological processes in them.

At the end of the study, the probe is removed from the vessel, and a pressure bandage. Typically, angiography rarely takes more than one hour. It is important to note that upon completion of the examination, the patient should remain in bed and also increase fluid intake.

Possible complications

Despite the high level of safety for patients of various ages, angiography may result in the development negative consequences for the patient. The most commonly observed conditions are:

release of a radiopaque substance from the vascular bed into the surrounding tissues. This situation can lead to inflammatory changes varying degrees expressiveness;
allergic reactions to the contrast agent or its individual intolerance. In such cases, the patient may experience itching, urticaria, Quincke's edema and other allergy-specific symptoms;
acute renal dysfunction, as a complication of the examination, is observed in patients with their diseases.

To prevent complications of the procedure, it is necessary to ensure a comprehensive examination of the patient before the study.

Angiography revealed an aneurysm in the internal carotid artery.

Speaking about what cerebral angiography is, it is important to note that this method is considered the “gold standard” in identifying cerebral vascular diseases. In this regard, if there is any suspicion of these diseases, the doctor can recommend the specified method of diagnosis to the patient. Before undergoing it, the patient must consult with the attending physician to identify possible indications and contraindications.

Literature: 1. “Neurology” Marco Mumenthaler, Heinrich Mattle; translation from German, ed. O.S. Levina; 2nd edition; Moscow, ed. "MEDpress-inform", 2009; 2. “Digital subtraction angiography.” Gonchar A. A. (15th hospital in Minsk), Gonchar I. A. (Research Institute of Neurology, Neurosurgery and Physiotherapy of the Republic of Belarus); The article was published in the magazine "News" radiology diagnostics" 1998 - 4: 34-37.

Portuguese neurosurgeon Egas Moniz performed the first angiography in 1927 carotid arteries and is recognized as the founder of the method of cerebral angiography. An angiogram serves in most cases for more accurate characterization and verification pathological processes identified using CT (computed tomography), MRI (magnetic resonance imaging) or ultrasound examination of cerebral vessels.

Indications. The most common indications for cerebral angiography (CA) include:

1. confirmation or exclusion of occlusions and stenoses of the extra- and intracranial parts of the cerebral arteries:
2. confirmation or exclusion of thrombosis of veins and sinuses;
3. confirmation or exclusion of aneurysms and subarachnoid hemorrhages;
4. confirmation or exclusion of specific arteriopathy, such as dissection, fibromuscular dysplasia, caliber irregularity and mycotic aneurysms in arteritis;
5. determine the characteristics of tumor vascularization;
6. obtaining additional information for performing endovascular interventions under radiological control for the treatment of aneurysms, arteriovenous malformations and fistulas, stenoses or vasospasm, as well as intra-arterial thrombolysis and mechanical retraction of thrombus.

Methodology. The catheter is inserted into femoral artery. Then, using a wire guide, it is passed into the brachiocephalic trunk, left common carotid or subclavian artery, after which a contrast agent is injected. Thin catheters for more selective examination can be inserted into the branches of large cerebral arteries. The image is obtained using digital technologies(digital [digital] subtraction angiography - DSA) The advantage of this method is that the results of angiographic examination can be integrated with data from imaging methods - CT and MRI, which makes stereotactic intervention easier and safer.

DSA method is based on intravenous or intra-arterial administration of small doses of contrast agent and enhancement of the image of the contrasted heart and blood vessels due to computer processing and subtraction (exclusion) of non-contrast images of objects that have no diagnostic value - the skeleton, soft tissues (Scheme). The high resolution of images obtained by this method allows the use of smaller doses of radiocontrast agents, or injection of contrast in a place remote from the object of interest.

A significant disadvantage of DSA is its lower resolution, the production of an image that does not correspond to the true dimensions, and the lack of connection between the detected changes and anatomical landmarks. The first of them is due to the design of the equipment: despite the most advanced settings, the resolution of DSA reaches only 2 pairs of lines per 1 mm, while standard angiography reaches 5 pairs of lines per 1 mm. Other shortcomings can be eliminated. The relationship between the resulting image and anatomical landmarks can be achieved by registering two images on film - the “mask” and the “fill”. To determine the true dimensions, it is enough to know the true outer diameter of the catheter, which can serve as a standard for X-ray measurements. Nevertheless, wide application DSA in the study of head and neck vessels is explained by the possibility of obtaining High Quality images at minimum concentration contrast agent (2-3%) in the vessels, while to perform standard angiography, the content of contrast agent in the blood of the artery being studied must be at least 40-50%.

Complications. Indications for angiography must be determined very strictly due to possible, although rare, complications. Angiography is an invasive and rather expensive research method. Bleeding and dissection of the vessel wall are possible at the injection site; the inserted catheter can destroy atherosclerotic plaques, leading to strokes due to arterio-arterial embolisms; Local vasospasm may develop due to the presence of a catheter in the vessel. In addition, there is a danger side effect contrast media, e.g. epileptic seizures, renal failure or anaphylactic shock. In the absence of arteriosclerosis, complications with angiography are observed less frequently.

Angiography of cerebral vessels is instrumental method research that allows you to literally “see” the blood vessels of the brain. To carry out the study, it is necessary to introduce a contrast agent into the corresponding vessel of the brain and the presence of an X-ray machine, with the help of which an image of the vessels filled with this contrast will be recorded. Angiography of cerebral vessels is not a routine diagnostic method; it has its own indications and contraindications, and, unfortunately, complications. What kind of diagnostic method is this, in what cases is it used, how exactly is it carried out and other nuances of cerebral angiography you can learn from this article.

Angiography in a broad sense is the acquisition of images of any blood vessels in the body using X-rays. Angiography of cerebral vessels is just one of the varieties of this extensive research method.

Angiography has been known to medicine for almost 100 years. It was first proposed by the Portuguese neurologist E. Moniz back in 1927. In 1936, angiography was used in clinical practice, and in Russia the method began to be used since 1954 thanks to Rostov neurosurgeons V.A. Nikolsky and E.S. Temirov. Despite such a long period use, angiography of cerebral vessels continues to improve to this day.

What is cerebral angiography?

The essence of this research method is as follows. The patient is injected into a specific cerebral artery (or the entire network of cerebral arteries) with an X-ray contrast agent, usually iodine-based (Urografin, Triiodtrust, Omnipak, Ultravist and others). This is done so that the image of the vessel can be recorded on x-ray film, since the vessels are poorly visualized with a regular X-ray. The introduction of a radiopaque substance is possible by puncture of the corresponding vessel (if technically feasible) or through a catheter connected to the required vessel from the periphery (usually from the femoral artery). When the contrast agent appears in the vascular bed, a series of x-rays in two projections (direct and lateral). The resulting images are evaluated by a radiologist, who draws conclusions about the presence or absence of a certain cerebral vascular pathology.

Varieties

Depending on the method of drug administration, this research method can be:

puncture (when contrast is administered by puncture of the corresponding vessel);
catheterization (when contrast is delivered through a catheter inserted through the femoral artery and advanced along the vascular bed to the required location).

According to the vastness of the area of study, angiography of cerebral vessels is:

general (all brain vessels are visualized);
selective (one pool is considered, carotid or vertebrobasilar);
superselective (a smaller caliber vessel in one of the blood pools is examined).

Superselective angiography is used not only as a research method, but also as a method of endovascular treatment, when, after identifying a “problem” in a specific vessel, this problem is “eliminated” using microsurgical techniques (for example, embolization or thrombosis of an arteriovenous malformation).

Due to the widespread introduction of modern diagnostic methods, such as CT scan(CT) and magnetic resonance imaging (MRI), in Lately CT angiography and MR angiography are being performed more and more often. These studies are carried out in the presence of appropriate tomographs; they are less traumatic and safer than just angiography. But more on that later.

Indications for use

Angiography of cerebral vessels is a specialized diagnostic method that should only be prescribed by a doctor. It is not performed at the request of the patient. The main indications are:

suspicion of arterial or arteriovenous;
suspicion of arteriovenous malformation;
determining the degree of stenosis (narrowing) or occlusion (blockage) of cerebral vessels, that is, establishing the lumen of the corresponding vessels. In this case, the severity of atherosclerotic changes in the vessels and the need for subsequent surgical intervention are established;
establishing relationships between cerebral vessels and those located nearby to plan surgical access;
control of the location of clips applied to the vessels of the brain.

I would like to note that just complaints of dizziness, headache, tinnitus and the like are not in themselves an indication for angiography. Patients with such symptoms should be examined by a neurologist, and based on the results of the examination, as well as other research methods, the need for angiography is determined. This necessity is determined by the doctor!

Contraindications

The main contraindications are:

allergic reaction (intolerance) to iodine preparations and other radiopaque substances;
pregnancy (due to ionizing radiation during the procedure). In this case, MR angiography may be performed;
mental illnesses that do not allow you to comply with all the conditions for the procedure (for example, a person will not be able to help but move during the photo);
acute infectious and inflammatory diseases(as the risk of complications increases);
violation of the blood coagulation system (both downward and upward);
the general condition of the patient, regarded as severe (this may be stage III heart failure, end-stage renal and liver failure, coma, and so on). Essentially, this subgroup of contraindications is relative.

Preparation for angiography

To obtain accurate results and reduce the risk of complications from the procedure, it is recommended:

pass the general and biochemical tests blood, including determining the indicators of the coagulation system (the statute of limitations for tests should not exceed 5 days). The blood type and Rh factor are also determined in case possible complications;
do an ECG and FG (FG, if one has not been performed within the last year);
do not drink alcoholic beverages for 14 days;
during the last week, do not take drugs that affect blood clotting;
perform an allergy test with a contrast agent. To do this, 0.1 ml of the corresponding drug is administered intravenously to the patient over 1-2 days and the reaction is assessed (the appearance of itching, rash, difficulty breathing, etc.). If a reaction occurs, the procedure is contraindicated!
the day before, take antihistamines (antiallergic) drugs and tranquilizers (if necessary and only as prescribed by a doctor!);
do not eat for 8 hours and do not drink water 4 hours before the test;
swim and shave (if necessary) the site of puncture or catheterization of the vessel;
Before the examination itself, remove all metal objects (hairpins, jewelry).

Research technique

At the very beginning, the patient signs consent to conduct this type of study. The patient is given an intravenous peripheral catheter to have instant access to the circulatory system. Then premedication is carried out (approximately 20-30 minutes before the procedure): antihistamines, tranquilizers, painkillers to minimize discomfort during the procedure and the risk of complications.

The patient is placed on the table and connected to devices (cardiomonitor, pulse oximeter). After skin treatment local anesthetic and anesthesia, a puncture of the corresponding vessel (carotid or vertebral artery) is performed. Since it is not always possible to accurately get into these arteries, most often a small incision is made in the skin and a puncture of the femoral artery, followed by immersion of the catheter and passing it through the vessels to the study site. Advancement of the catheter along the arterial bed is not accompanied by pain, since the inner wall of the vessels is devoid of pain receptors. The catheter's progress is monitored using x-rays. When the catheter is brought to the mouth of the required vessel, a contrast agent in a volume of 8-10 ml, preheated to body temperature, is injected through it. The administration of contrast may be accompanied by the appearance of a metallic taste in the mouth, a feeling of heat, and a rush of blood to the face. These sensations go away on their own within a few minutes. After the administration of contrast, x-rays are taken in frontal and lateral projections almost every second several times (which allows you to see the arteries, the capillary phase, and veins). The photographs are developed and immediately assessed. If something remains unclear to the doctor, an additional portion of contrast agent is injected and the images are repeated. Then the catheter is removed, and a sterile pressure bandage is applied to the puncture site of the vessel. The patient must be monitored medical staff for at least 6-10 hours.

Complications

According to statistics, complications during this diagnostic method occur in 0.4-3% of cases, that is, not so often. Their occurrence may be associated both with the procedure itself (for example, bleeding from the puncture site of a vessel) and with the use of a contrast agent. It should be borne in mind that compliance with all conditions when preparing and performing angiography is the prevention of possible complications. Use of iodine-containing drugs latest generation(Omnipak and Ultravist) is characterized by lower statistics of complications.

So, possible complications of cerebral angiography are:

vomit;
allergic reaction to an iodine-containing drug: itching, swelling and redness at the injection site, followed by the appearance of shortness of breath (reflex breathing disorder), drop in blood pressure, disturbance heart rate. In severe cases, anaphylactic shock may develop, which is life-threatening condition;
spasm of cerebral vessels and, as a consequence, acute disorder cerebral circulation(up to );
seizures;
penetration of contrast agent into soft fabrics in the area of vessel puncture (outside the vascular bed). If the volume of the drug spilled into the tissue is up to 10 ml, then the consequences are minimal, but if more, then inflammation of the skin and subcutaneous fat develops;
leakage of blood from the puncture site of the vessel.

CT and MR angiography: what are the features?

CT and MR angiography of cerebral vessels are inherently a similar study as angiography. But there are a number of features of these procedures that distinguish them from angiography of cerebral vessels. That's what we'll talk about.

it is performed using a tomograph rather than a conventional X-ray machine. The study also relies on X-rays. However, its dose is significantly less than with conventional angiography of cerebral vessels, which is safer for the patient;
computer processing of information allows you to obtain a three-dimensional image of blood vessels at absolutely any point of the study (this applies to the so-called spiral CT angiography, carried out on a special spiral tomograph);
the contrast agent is injected into the vein of the elbow bend, and not into the arterial network (which significantly reduces the risk of complications, since the administration of the drug becomes routine intravenous injection via a peripheral catheter).
To perform CT angiography, there is a restriction on the person’s weight. Most tomographs can withstand body weights of up to 200 kg;
the procedure is carried out in outpatient setting and does not require observation of the patient after its completion.

MR angiography is characterized by the following features:

it is carried out using a magnetic resonance imaging scanner, that is, the method is based on the phenomenon nuclear magnetic resonance. It means complete absence X-ray radiation during the procedure (and therefore MR angiography is allowed during pregnancy);
can be performed both with the use of a contrast agent (for better visualization) and without it (for example, in case of intolerance to iodine preparations in patients). This nuance is undeniable
advantage over other types of angiography. If it is necessary to use contrast, the substance is also injected into the ulnar flexure vein through a peripheral catheter;
the image of the vessels is obtained three-dimensional thanks to computer processing;
a series of images takes a slightly longer period of time compared to other types of angiography, and the person needs to lie in the tomograph tube the entire time. For people suffering from claustrophobia (fear of closed spaces) this is impossible;
the procedure is contraindicated in the presence of an artificial pacemaker, metal clips on blood vessels, artificial joints, electronic implants of the inner ear);
is performed on an outpatient basis, and the patient is immediately sent home.

In general, we can say that CT and MR angiography are modern, less dangerous and more informative research methods than conventional angiography of cerebral vessels. However, they are not always feasible, so conventional angiography of cerebral vessels is still a relevant method for studying vascular pathology of the brain.

Thus, angiography of cerebral vessels is a very informative diagnostic method, mainly vascular diseases brain, including stenoses and occlusions that cause strokes. The method itself is quite affordable; it only requires an X-ray machine and a contrast agent. If all conditions for preparing and conducting the study are met, angiography of cerebral vessels gives an accurate answer to the question posed to it with a minimum number of complications. Besides modern medicine has such innovative methods as CT and MR angiography, which are more harmful, less harmful and traumatic for the patient. CT and MR angiography make it possible to obtain a three-dimensional image of the vessels, which means that it is more likely not to miss the existing pathology.

Medical animation on the topic “Cerebral angiography”:

Modern medicine is developing incredibly quickly. Now you won’t surprise anyone with ultrasound and X-ray examinations. But even these surveys are becoming more and more advanced from year to year. Angiography is one such method that allows you to see the size, shape, and contours of the vessel.

How can you see the blood vessels of the brain?

Cerebral angiography is an x-ray method for visualizing cerebral vessels, which consists of staining the vascular bed with previously administered contrast. This is a highly effective and modern diagnostic method that allows you to make an accurate diagnosis.

The method of visualizing blood vessels using a contrast agent has been known to medicine for about a century. Back in 1927, a neurologist from Portugal began using this method, and it came to Russia in 1954. Despite such long-term use, cerebral vascular angiography has changed significantly during this time, becoming more advanced.

The essence of the method

In order for the radiologist to see, an iodine-based X-ray contrast agent (Triiodtrust, Ultravist) is injected into one of the cerebral arteries. Injection is possible either into a vessel in the brain or through a catheter through an artery on the periphery, for example, the femoral one. Without this procedure, cerebral angiography of the cerebral vessels will be ineffective, since the arteries will be poorly visible on the image.

Types of cerebral angiography

There are several classifications of this type of examination. It is divided depending on the method of administration of the drug, as well as on the number of vessels that are included in the examination.

The following types of this examination are distinguished depending on the method of injection of the X-ray-containing substance:

puncture or direct - contrast is injected directly into the brain vessel using a puncture;
catheterization or indirect - contrast is administered using a catheter through the femoral artery.

Depending on the extent of the vessels that can be visualized, the following types of angiography are distinguished:

general angiography - the entire vascular network of the brain is visible;
selective cerebral angiography of the brain - one of the pools can be examined (in total, there are two blood supply pools in the brain: vertebrobasilar and carotid);
superselective angiography - individual small-caliber vessels are visualized in one of the pools. It is used not only as a diagnostic method, but also for treatment, in which immediately after visualizing the location of the thrombus or embolus in the vessel, it is removed.

Indications

A doctor's referral is required to examine the brain using cerebral angiography. This diagnostic method is not carried out only at the request of the patient.

The main indications are:

suspicion of the presence of a cerebral aneurysm (sac-like bulging of the artery wall);
determination of the degree of narrowing of the lumen of the vessel by atherosclerotic plaques (narrowing of more than 75% significantly aggravates blood circulation in the brain, is an indication for surgical intervention);
control of the location of clips pre-installed on the vessels;
diagnosis of arteriovenous malformation (pathological connections between arteries and veins; usually congenital);
suspicion of the presence of tumors, while the angiogram visualizes a change in the normal vascular pattern at the site of the tumor;
visualization of the arteries of the brain during volumetric processes in it (tumors, cysts) in order to establish the location of the vessels relative to each other;
suspicion of cerebral angioma ( benign tumor formed by the vascular wall);
lack of information when using other neuroimaging methods (CT, MRI), but in the presence of patient complaints and symptoms of the disease.

Contraindications

Carrying out both indirect and direct cerebral angiography has a number of contraindications:

Allergy to iodine and iodine-containing substances. In this condition, the contrast can be replaced with gadolinium. If there is an allergy to other contrast components, it is necessary to completely abandon this examination method.
Kidney and liver failure in the stage of decompensation. These conditions lead to impaired removal of contrast from the body.
Heavy chronic diseases.
Acute inflammatory diseases, as the symptoms of infection may worsen.
Age up to two years, as radiation impairs the growth and development of the child.
The period of pregnancy and lactation, since x-ray irradiation has a detrimental effect on the fetus.
Mental illness during the period of exacerbation.
Bleeding disorders (hemophilia, thrombocytopenic purpura), which increases the possibility of bleeding after contrast administration.

Preparing for the examination

Since the examination method is X-ray with the introduction of a contrast agent, you need to carefully prepare for cerebral angiography. Preparation includes the following actions:

Submit a maximum of 5 days before the examination general analysis blood and urine (to determine the condition of the kidneys and exclude the presence infectious diseases), coagulogram (to determine blood coagulation function).
Do electrocardiography and phonocardiography (to exclude heart diseases).
Do not drink alcohol for at least two weeks before the examination.
Do not take medications that affect blood clotting for at least a week before angiography.
1-2 days before the examination, perform an allergy test with contrast, which is carried out by administering 0.1 ml of the drug to the patient and further observation for skin reactions. If redness, rash, and itching do not appear on the skin, then the test is negative and angiography is possible.
Do not eat anything 8 hours before the examination and do not drink anything during the last 4 hours.
It is possible to take tranquilizers or herbal sedatives with significant anxiety. However, it should be remembered that these medications can only be taken as prescribed by a doctor!
If necessary, shave the contrast injection site.
Remove all jewelry and other metal objects before angiography.
Immediately before undergoing the examination, medical personnel must explain to the patient the methodology, goals and possible risks this examination method.

Methodology

Before conducting the examination, the doctor must obtain written consent from the patient. After placing a catheter in a peripheral vein, necessary for immediate administration of drugs, the patient is premedicated. He is given painkillers and a tranquilizer to achieve maximum patient comfort and relieve pain. The patient is connected to special devices to monitor his vital functions (oxygen concentration in the blood, pressure, heart rate).

Next, the skin is treated with an antiseptic to prevent infectious infection, and contrast is injected into the carotid or vertebral artery during direct angiography, into the femoral artery during indirect angiography. If indirect angiography is performed, a catheter is also inserted into the femoral artery, which is pushed through the vessels into the desired artery in the brain. This procedure completely painless, since the internal vascular wall has no receptors. The movement of the catheter is monitored using fluoroscopy. Most often, indirect angiography is performed.

When the catheter has reached the required location, a contrast volume of 9-10 ml is injected into it, having previously been warmed to body temperature. Sometimes, a few minutes after the administration of contrast, the patient is bothered by a feeling of heat, the appearance bad taste metal in the mouth. But these feelings quickly pass.

After the contrast is introduced, two x-ray brain - in lateral and direct projections. The images are assessed by a radiologist. If there are still uncertainties, it is possible to reintroduce contrast and take two more photographs.

At the end, the catheter is removed, a sterile bandage is applied to the insertion site, and the patient is monitored for 24 hours.

Possible complications

Adverse reactions and complications during cerebral angiography of cerebral vessels occur infrequently, up to 3% of cases. However, such reactions may occur, and the patient must be informed about them. Among the main possible complications are the following conditions:

allergic reactions: mild - redness skin, itching, rashes, up to severe - Quincke's edema and anaphylactic shock;
development of cerebral stroke due to arterial spasm;
seizure attack;
bleeding at the puncture site;
penetration of contrast into the soft tissue surrounding the vessel, which can lead to inflammation;
nausea and vomiting.

Features of CT angiography

Since the angiography method has been used for more than a century, it is constantly being improved. A more modern and high-quality method for visualizing cerebral vessels is cerebral CT angiography. Although in general the survey method is similar to the traditional one, there are some peculiarities:

It is carried out not with the help but with the help of a tomograph. Also based on the passage of X-rays through the human body, it takes a large number of images at once, layer by layer, which makes it possible to more accurately visualize the vessels and surrounding tissues.
The image turns out to be three-dimensional, which allows you to view the vessel from all sides.
The contrast injection is given into a vein, not an artery.
There is no need to keep the patient under observation after the procedure.

CT angiography is a more effective and safe method of vascular imaging.

Features of MR angiography

MR angiography is even more informative than CT. It allows you to see soft tissues that are difficult to visualize on CT. It is carried out using a magnetic resonance imaging scanner and is not X-ray method, unlike other angiography methods. This avoids exposure to radiation.

Another advantage is good visualization even without the use of contrast, which is why MR angiography without contrast can be used for allergy sufferers.

The main contraindication for use is the presence of any metal objects in the body ( artificial drivers rhythm, prostheses, implants, metal clips on blood vessels).

Perhaps selective cerebral angiography of the brain has already become commonplace and routine for doctors. It may be inferior in effectiveness to CT and MRI angiography. However, being more affordable and not requiring special high-tech equipment, it is still actively used 100 years later for diagnosing brain diseases.