Cerebral angiography. Angiography of cerebral vessels: what is it, indications and contraindications How is the study of the vessels of the brain and neck performed?

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 (the catheter with contrast is brought to the abdominal or thoracic aorta), selective angiography of neck vessels (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 is simulated vascular bed).

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 pathologies of blood vessels 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 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 valuable diagnostic procedure not only for 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 future operation, 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 there is excessive anxiety, 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 assess 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, renal failure in the terminal stage, 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 surgical intervention, as with classical angiography;
• X-ray load is reduced;
• the results are much more informative than with classical way. 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 research on the effect on the fetus magnetic field were not carried out);
• 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 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 areas where contrast is administered are mandatory equipped with medications that will help provide emergency assistance to the patient in case of an allergic reaction.

Second option possible complications- extravasation of contrast. Occurs if contrast agent is used instead venous vessel got into soft fabrics Around him. 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 substance leaks, there will be no serious complications, but if more, fatty tissue becomes inflamed, tissue necrosis at the injection site is possible.

The third variant of complications is kidney failure in acute form. 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 in the presence of some shortcomings, angiography remains good option diagnosis of cerebral vascular pathologies.

Selective cerebral angiography (SCA) is an x-ray method for studying individual sections of the cerebral circulatory network. It is based on contrasting blood vessels followed by radiography of the vascular pattern. It is a clarifying diagnosis in cases where the results of CT or MRI suggest damage to the cerebral vessels.

On a note! Selective cerebral angiography allows you to correctly diagnose, determine a treatment regimen for cerebral vessels and prescribe effective medicines, determine the methodology and tactics surgical treatment for vascular pathologies.

Indications for angiography are:

• the need to clarify vascular pathologies;
• suspicion of a neoplasm;
• frequent headaches, dizziness or loss of consciousness;
• suffered a stroke;
• traumatic brain injury;
• epilepsy.

Contraindications

List of contraindications for cerebral angiography:

• renal failure;
• allergy to iodine-containing drugs;
• blood clotting disorder;
• pregnancy;
• age up to two years;
• myocardial infarction;
• exacerbation of mental illness.

Preparing for the SCA

Before angiography, preparation is required, including the following steps:

• blood test, mainly for HIV, RW, hepatitis B, C;
• Analysis of urine;
• sensitivity test to iodine preparations;
• fasting diet for 10 hours before the study;
• taking tranquilizers 12 hours before the test.

Methodology for conducting SCA

Carotid artery catheterization

Direct carotid angiography involves catheterization of the carotid artery.

The patient is laid down, the head is turned in the opposite direction and thrown back. The puncture point is determined by the pulsation of the carotid artery - it is located between the upper level of the thyroid cartilage and inside sternocleidomastoid muscle.

Currently practically not used.

Catheterization of the vertebral artery

With direct vertebral angiography, catheterization of the vertebral artery can be performed in different ways.

1. Direct puncture of the vertebral artery. An angiographic needle is inserted at the level of the IV–V cervical vertebrae, advanced to their transverse processes and the vertebral artery is punctured between them.
2. Puncture of the subclavian artery. In the area of ​​the clavicle, the pulsation of the subclavian artery is palpated, it is punctured with a needle and a catheter is inserted to the branch of the vertebral artery.
3. Brachial artery puncture produced in the armpit. A catheter with a side hole and an internal plug is inserted into the lumen of the needle and advanced to the mouth of the vertebral artery. Then a catheter of smaller diameter is inserted through it on a flexible metal string.

Currently, these accesses are practically not used.

It is important! Since the lumen of the vertebral artery is smaller than that of the femoral and carotid arteries, the contrast agent must be supplied more slowly.

Femoral or radial artery catheterization

More often selective angiography carried out using the indirect method. In this case, catheterization of the femoral or radial artery is performed. This method makes it possible to diagnose four arteries at once: two paired carotid and two paired vertebral arteries.

For this:

1. Prepare the puncture site.
2. Palpated femoral artery in the medial third inguinal ligament or radial artery in its distal segment.
3. After inserting the main catheter, it is advanced along the vessel to the aortic arch.

Arterial catheterization technique

When performing SCA, arterial catheterization is performed using the following technique:

1. An angiographic needle punctures the skin at an acute angle.
2. Move the needle forward until the artery pulsates.
3. They pierce the artery with a sharp push, trying not to damage its opposite wall.
4. After a stream of blood appears, a conductor is inserted into the needle, secured, and the needle is removed.
5. Using a guidewire, an introducer-dilator is inserted into the vein. It is necessary for atraumatic installation of the catheter and is equipped with a three-way stopcock to prevent blood loss.
6. The guidewire is removed and the catheter is inserted into the introducer lumen.

On a note! Advancement of the catheter along the vascular bed is absolutely painless, since the inner walls of the vessels are devoid of pain receptors.

Use of contrast agents

Radiocontrast agents are used in angiography to visualize blood vessels.

1. Ionic ones can provoke an allergic reaction, causing an increase in the osmotic concentration of blood plasma.
2. Non-ionic ones are much safer, but their cost is higher.

Table 1. Iodine-containing contrasts.

Compound	Drug name	Active substance	Osmolarity level
Ionic	Vizotrust Urografin Verografin Trazograph Diatrizoate	Sodium amidotrizoate	High
Ionic	Hexabrix 320 Ioxaglat	Ioxagloic acid	Short
Nonionic	Iopamidol Yopamiro Scanlux Tomoscan	Iopamidol	Short
Nonionic	Yomeron	Yomeprol	Short
Nonionic	Omnipack Introvise Iohexol	Iohexol	Short
Nonionic	Oxylan Telebrix	Yoxitalamic acid	Short
Nonionic	Yopromide Ultravist	Yopromide	Short
Nonionic	Iodixanol	Iodixanol	Short
Nonionic	Optiraeus	Ioversol	Short

One of the mandatory points in preparation for angiography is iodine sensitivity test. It consists of slowly injecting 2 ml of contrast intravenously and observing the body’s reaction for three to four hours. On this moment With the use of modern non-ionic contrasts, this procedure is not required.

The examination is canceled if the following symptoms appear:

• skin redness;
• rash;
• swelling;
• nausea and vomiting;
• headache;
• cough;
• suffocation.

Before introducing an iodine-containing drug into the catheter, it is heated to body temperature. The rate of administration should be commensurate with the speed of blood flow.

Possible unpleasant sensations are a metallic taste in the mouth, a rush of blood to the face, a feeling of heat throughout the body, especially in the pelvic area.

Remember! All radiopaque agents are nephrotoxic. If renal function is impaired, strict monitoring of creatinine and urea levels is necessary.

Tools needed to conduct SCA

The following set of instruments is used to perform angiography:

• puncture angiographic needle;
• standard conductor with Teflon coating;
• introducer-dilator;
• catheter, sometimes of slightly different diameters.

Angiographic installation

The angiography procedure is performed in the Department of X-ray and Surgical Methods of Diagnostics and Treatment.

The angiographic installation consists of the following complex:

1. A table that transmits x-rays and moves in a horizontal plane.
2. X-ray tube with electron-optical converter.
3. Image recording and playback system.
4. Monitor.

Series x-rays performed in frontal and lateral projections, at a speed of one or several images per second. Simultaneous recording allows, at the end of the study, to examine each image in detail and decipher it.

Complications

Possible complications after angiography:

1. Allergic reaction to iodine, up to anaphylactic shock.
2. Development of acute renal failure.
3. Angiospasm, fraught with violation cerebral circulation and stroke.
4. Convulsive attacks.
5. Arterial thrombosis as a consequence of prolonged catheterization.
6. Bleeding at the puncture site.

If symptoms of cerebral vasospasm appear, treatment should be started as soon as possible. Papaverine tablets cause vasodilatation and increased blood flow, but they must be taken under the supervision of a doctor.

Remember! The main symptoms of vasospasm:

• headache;
• dizziness;
• noise in ears;
• nausea;
• loss of orientation;
• speech disorder.

Other types of angiography

In addition to classical angiography, there are two more methods for performing it:

• computed tomography (CT) angiography;
• magnetic resonance (MR) angiography.

During computed tomographic angiography, a radiopaque contrast agent is injected into the patient's circulatory system and a series of layer-by-layer X-ray images are taken.

Then, using a special computer program, 3 D-reconstruction of blood vessels. In this case, veins and arteries are stained different colors and a three-dimensional model of their spatial location is obtained.

Magnetic resonance angiography is performed on a magnetic resonance imaging scanner.

The essence of the method is that images of blood vessels are obtained without the use of radiocontrast agents. Although gadolinium-based contrast agents are sometimes used to obtain a clearer image.

Table 2. Advantages and disadvantages various methods angiography.

Type of method	Advantages	Flaws
Classic angiography	Maximum information content, especially when using rotational angiography with 3D modeling. Possibility of combining diagnostic and therapeutic procedures.	Invasiveness. Exposure to X-rays on the body. Possibility of an allergic reaction to iodine. Nephrotoxicity of contrast agents.
	Lower radiation dose. Less invasive (puncture of a vein rather than an artery).
	No X-ray exposure. Possibility of studying brain tissue in various modes.	High price. Possibility of claustrophobia. Contraindication if you have a pacemaker.

Interpretation of angiographic study results

Cerebral angiography requires coordinated action of an anesthesiologist, vascular surgeon and radiologist.

The results can be correctly interpreted only after carefully studying the images obtained and comparing them with the existing symptoms.

Table 3.

Visual picture	Relevant pathology
The contrast agent passes from the arteries to the veins, excluding capillaries	Arteriovenous malformation Dural fistula
Abrupt break in the image of the vessel	Thrombosis, occlusion
Narrowing of the artery, slow spread of contrast agent	Atherosclerosis Vessel stenosis
Release of contrast into surrounding tissue	Aneurysm rupture (can usually be imaged intraoperatively during aneurysm embolization)
Uneven contours of the vessel, protrusion of the wall	Atherosclerosis Aneurysm
Asymmetry of blood flow in the venous sinuses, Contrasting the cavernous sinus from the carotid artery	Carotid-cavernous anastomosis

Traditional methods of treating blood vessels

Since the majority vascular diseases develops as a consequence of atherosclerosis, cleaning of brain vessels at home should be aimed at expanding the lumen, preventing and removing cholesterol plaques.

Some folk recipes vascular treatment:

1. For 100 g of honey, take one lemon and one head of garlic, grind with a blender or meat grinder, leave in a dark place for a week. Use 1 tbsp. l. twice a day.
2. Take 5 tbsp. l. rose hips and 10 tbsp. l. hawthorn fruits, chop them, pour two liters of boiling water. Leave for a day in a dark, warm place. Take one glass three times a day.
3. Grind 2 tbsp. l. Sophora japonica fruits, place in half a liter of boiling water and boil for 5 minutes. Strain, cool. Take 1/3 cup twice a day.

Remember! Folk remedies are not always completely safe. Therefore, you should start treatment only after consulting a doctor!

Related Posts

From this article you will learn: what angiography is, what it is intended for, and in diagnosing which diseases it is impossible to do without it. What types of angiography exist, how dangerous are they, and which one is the best? How the study works and how to prepare for it. Which specialists carry out such diagnostics, where it can be done and how to decipher the results.

Article publication date: 04/04/2017

Article updated date: 05/29/2019

Angiography is a method of X-ray contrast diagnostics of vascular diseases. It allows you to see and study the vessels of any area human body(head, limbs, heart, etc.) and evaluate:

• The presence of normal and accessory arteries, how and where they are located.
• How preserved is their lumen, and are there any narrowings (stenosis) or expansions (aneurysms) that impair patency.
• The structure and integrity of the vascular wall.
• How well is the blood flow?

Angiography is the most accurate and reliable among all existing techniques diagnosis of vascular pathology. She is part of the group high-tech procedures which are carried out using modern equipment that emits X-rays. It is carried out in specialized centers by angiosurgeons. Indications are established by doctors of different specialties, which depends on the type vascular disorders– cardiologists, cardiac surgeons, neurologists and neurosurgeons, vascular surgeons and oncologists.

Equipment for angiographic examination

The essence and principle of the method

Angiographic diagnostics allows you to obtain a visual image (picture) of large and small vessels of the studied anatomical region of the body. Its principle is similar to a conventional x-ray examination of bones or the chest - x-rays, passing through tissues, are absorbed differently by them, which is displayed on a special film in the form of a silhouette of the structures being studied.

But it is no coincidence that angiography refers not to general, but to special (contrast) X-ray methods. After all, vessels are soft tissue formations, therefore, like other soft tissues (skin, muscles, tendons, etc.), they are not visible on a regular x-ray. In order for them to become visible to the rays, they need to be contrasted - to puncture the vessel, install a catheter in its lumen and fill it with an X-ray contrast agent that reflects radiation well.

Thanks to modern digital and computer technologies, it is possible to obtain not only an image of individual vessels filled with a contrast agent, but also an image on film. It is possible to model it in different planes (for example, 3D) and video record the process of filling the entire arterial bed with contrast. This method allows not only to determine whether there is pathology in it, but also to detail important anatomical features: how and where the vessels pass, how much their lumen and walls are changed, whether there are additional (collateral) blood flow paths.

Types of angiography and their purpose

Depending on which vessels are examined and with what technologies, angiography can be different. Its most common varieties are shown in the table.

Types of angiography	What is it - the essence and features of the technique, and what can be investigated
Depending on the vessels studied	Arteriography – study of arteries
	Phlebography – examination of veins
	Lymphangiography - study of lymphatic ducts
Depending on the technology depicting the vessels	Standard technique - on a digital fluoroscope
	CT angiography – using computed tomography
	MRI angiography – using magnetic resonance imaging
Depending on the location and name of the vessels	Cerebral angiography – cerebral arteries
	Aortoarteriography – aorta and arteries of internal organs that branch from it (renal, intestinal, etc.)
	– arteries of the heart
	Angiopulmonography – pulmonary vessels
	Arteries and veins of the lower extremities
	Portography – liver veins

Given the rapid growth of vascular pathology, the most popular type of angiography is considered to be arteriography of the heart, brain and lower extremities. The vessels can be most accurately studied using multislice tomography (computed or magnetic resonance imaging) or digital angiography with three-dimensional visualization technology.

CT angiography device

What diseases can be diagnosed - indications for research

Vessels of large, medium and small caliber (diameter from 2–3 cm to 1–2 mm) are available for angiographic examination. This allows the method to be used for diagnosing pathologies accompanied by impaired blood supply to organs and tissues:

• atherosclerosis (narrowing (occlusion) of the lumen by atherosclerotic plaques);
• thrombosis and (complete blockage (obliteration) by blood clots);
• aneurysm and malformation (abnormal expansion with thinning of the wall, threatening its rupture);
• compression of the artery by the tissues with which it comes into contact;
• a tortuous course or abnormal location of the vessel, impeding blood flow through it;
• excessive vascular branches and accumulations that should not be normal, which indicates a tumor process.

The most common pathologies for which angiography is indicated are described in the table.

Application area	Diseases and pathological conditions that can be diagnosed
Neurology and neurosurgery	Ischemic stroke
	Encephalopathy
	Cerebral atherosclerosis
	Intracerebral hemorrhage
	Aneurysms and malformations of cerebral arteries
Cardiology and cardiac surgery	Ischemic disease (angina)
	Coronary atherosclerosis
	Myocardial infarction
	Pulmonary embolism
Vascular surgery	Atherosclerosis, thrombosis and embolism: arteries of the lower extremities; aorta and its branches supplying blood internal organs(intestinal, renal); carotid and other arteries of the neck; arteries of the upper extremities.
	Venous thrombosis and postthrombophlebitic syndrome of the lower extremities and liver
Oncology	Malignant tumors of any location (brain, internal and pelvic organs, soft tissues of the limbs and torso)

Depending on the indications and the existing pathology, angiography can be either purely diagnostic or combine diagnostic and medicinal purposes. This means that during its implementation, if necessary, it is possible to carry out manipulations that eliminate the detected pathology (stenting (expansion of narrowed areas) of arteries, their embolization (blocking the lumen) in case of wall rupture, hemorrhages and tumors).

How it all happens: stages of the procedure

Angiography can only be performed in special diagnostic centers equipped with modern equipment. The procedure is represented by the following stages and manipulations:

1. The subject lies on his back on a special angiography table.
2. Under sterile conditions (as in an operating room), the area in which the vessel will be punctured is treated with antiseptics (alcohol, betadine, iodine):

• One of the inguinal-femoral areas (femoral artery) is a universal point from which any vascular system of the body (cerebral, aortic, coronary, upper and lower extremities) can be filled with contrast.
• The inner surface of the shoulder or forearm (brachial, radial or ulnar artery) - if you need to examine the vessels of the head and upper extremities.

Using special needles, the skin and the vessel that needs to be punctured are pierced.

A tubular probe is inserted into the lumen of the artery - an introducer, which plays the role of a conductor-port for other probes and instruments.

Through the installed introducer, a long thin catheter (about 2 mm thick) is inserted into the lumen of the artery.

A syringe filled with a radiopaque iodine-containing drug (this can be Verografin, Urografin, Triombrast, Cardiotrast) is connected to the catheter.

At the moment of injection of the drug into the lumen of the artery, X-ray radiation passes through the area under study, which makes it possible to see on the monitor the silhouette of the vessels being examined and the location of the catheter.

Under the control of the monitor, the catheter is brought to the vessel that needs to be examined - filled with contrast and an image taken.

After obtaining the desired image, the catheter and introducer are removed alternately.

The puncture site of the skin and artery is sealed with a sterile napkin and pressed tightly for several minutes to prevent bleeding from the puncture site.

The total duration of angiography ranges from 10–15 minutes to an hour.

If angiography is performed using magnetic resonance or computed tomography, the procedure can follow the classic algorithm described above, or it can be simplified. In the first case, the research will be the most reliable and informative. A simplified scheme involving the introduction of a contrast agent not into an artery, but into the cubital vein (like a regular intravenous injection), also makes it possible to study the vessels, but not as accurately as with intra-arterial administration.

How to prepare for research

Angiography is an invasive diagnostic method, since during its implementation the integrity of tissues - large arteries - is disrupted. Its additional danger is the need to administer drugs that can cause severe allergic reactions. Therefore, it is imperative to prepare for it. The decision about the need for angiography can only be made by a specialist, comparing the potential benefits and harms from it.

Classical training includes the following rules:

• Full examination: general and biochemical blood and urine tests, coagulogram (clotting), group and Rh factor, blood sugar, markers viral hepatitis and Wasserman reaction, ECG, and, if necessary, ultrasound of the heart and blood vessels.
• The study is carried out on an empty stomach and after emptying the bladder.
• A week before the procedure, do not drink any alcoholic beverages, and also reduce the dose of blood thinning medications (Clopidogrel, Warfarin, Aspirin, Heparin) as much as possible or stop taking them altogether (only after consulting a doctor!).
• Tell your doctor if you have any allergic reactions, especially to iodine!
• A few hours before angiography or 1-2 days before it, a test for an X-ray contrast agent is carried out - 0.1-0.2 ml is injected intravenously. If after the test there are no allergic manifestations(itching, redness, skin rash, shortness of breath, falling blood pressure, pain in the eyes), the study can be carried out.
• The morning of the procedure, shave the hair in the area where the artery will be pierced.
• 1–2 hours before the test, you can take antiallergic and sedative drugs (Loratadine, Gidazepam, etc.) or administer more strong remedies in injections, if there are medical indications.

Tests to be performed before angiography

If angiography is performed in an emergency (for example, during a heart attack), preparation time is reduced to a minimum. But it is imperative to follow the most important rules - determining the reaction to an iodine-containing drug, emptying the stomach and bladder.

Contraindications

The most common contraindications for which angiography cannot be performed:

1. Allergy to iodine.
2. Heavy general state patient due to incurable or decompensated chronic diseases(hepatic-renal, cardiac, pulmonary failure, oncopathology).
3. Acute inflammatory, suppurative and infectious diseases.
4. Thrombophlebitis, if contrasting of veins (phlebography) is necessary.
5. Severe mental disorders.
6. Pregnancy.

The first two contraindications are absolute – research is impossible. Other contraindications may be temporary or relative - if the benefit of the study exceeds its risk.

Angiography – reliable, highly informative modern method diagnosis of vascular diseases. Despite the existing risks and opportunities dangerous complications, with a correct assessment of indications, contraindications and compliance with the technique, in 95–98% the study does not cause any negative consequences.

Cerebral angiography of cerebral vessels is a modern instrumental diagnostic procedure that allows you to literally see the required area 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 the general 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 improved method is called multispiral 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 opportunity to conduct the examination.

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 about headache, tinnitus, dizziness and others similar symptoms, are not a reason to carry out 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 existing risks, it will be necessary to sign an agreement to conduct this study. Only after this the preparation process begins.

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

If you can't find 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. From some medicines you will have to refuse, for example, those that affect blood clotting.

You are prohibited from eating 12 hours before the start of the study. At the time of diagnosis, the patient should not have any metal objects.

Research process

Before the puncture is made, the puncture site is treated with an antiseptic drug. So that the patient does not experience discomfort, anesthesia is administered, 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 regular topic what dose radiation exposure, 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 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 exercise contraindicated. You should drink as much fluid as possible, but do not water procedures. You can remove the bandage from the puncture site only after the doctor’s permission.

Percent fatal outcome from angiography of the vessels of the brain and neck is small, but it is still there. For this reason, you should be careful when choosing medical institution where this procedure will be carried out.

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Modern medicine is developing incredibly quickly. Now you won’t surprise anyone with ultrasonic 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 to use 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 you are allergic to other contrast components, you must completely avoid this method examinations.
• 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 the examination medical staff must explain to the patient the methodology, goals and possible risks of 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 administered 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. More modern and qualitative method visualization of 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 poorly visualized on CT. It is carried out using a magnetic resonance imaging scanner and is not an 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.