Transcript Cerebral Angiography - Oregon Institute of Technology

Cerebral Angiography
Jessica Birt
CIT
Noah’s Ark-----
Introduction
• Angiography: study of blood vessels, by
the use of contrast to make the vessels
visible under fluoroscopic procedures.
• Cerebral angiography: specifically looking
at the vessels of the brain
– Done to detect abnormalities, blockages, or
for therapeutic reasons
Indications
•
•
•
•
Narrowing or blockage
Acute stroke
Therapeutic reasons
“Map” of the brain prior to
neurosurgery
• Bleeding within the skull
• Inflammation
• Bulges in arterial walls/
Aneurysms
• Blood clots in the brain
• Intracerebral hemorrhage
• Arteriovenous & fistulae
malformations
• Highly vascular extraand intra cranial tumors
Bleeding Brain
Cerebral Aneurysm
Risks
• Internal bleeding and hemorrhage
– Involves puncturing an artery
• Stroke or heart attack
– Blood clots or plaque dislodge forming a
blockage
• Allergic reaction
– To contrast
Contraindications
–Pregnancy
–Coagulation
ability
–Kidney
disease
Anatomy
Major vessels involved in cerebral angiography
include:
–Carotid arteries: supply blood to the
anterior and middle portions of the brain
–Vertebral arteries: supply blood to the
posterior portions of the brain
–Jugular veins: venous drainage of the
brain
–Femoral artery: accessed site for arterial
puncture
Preprocedural Care and
Cautions
• Review patients medical history and lab results
• This will give the physician a better understanding of the
condition of the patient
• Establish and understanding
• Patient needs to know what to expect, risks, complications
etc.
• Must have permission in the form of written
informed consent
Equipment
– Image intensifier fluoroscopic unit
– Angiographic table with movable or freefloating top
– Rapid sequence film changers
– Electromechanical contrast injector
– Digital subtraction capabilities
– Sterile tray set up with all the appropriate
tools for a cerebral angiogram
– Guidewires: based on personal preference
– Catheters: based on personal
preference/single end hold w/no side holes
Contrast
• Past: used ionic iodinated contrast
• Today: use nonionic iodinated contrast
– Iohexol, iopamidol, ioversal, imagopaque
Amount injected depends on condition, age,
weight and pathology of vessels
Procedure Details
• Local anesthetic at
puncture site
• Small incision over
the femoral artery
• Needle placed into
vessel using
Seldinger Technique
• Guidewire placement
• Catheter placement
• Contrast injected
Common Filming Positions
• Carotid Arteries:
anteroposterior axial
lateral
anteroposterior
oblique
• Vertebral Arteries:
anteroposterior axial
lateral
Lateral
Views of
Carotid
Arteries
Digital Subtraction
• Useful for vessels that
cannot be seen due
to bony structure
overlapping.
• Arterial, capillary,
venous phase
subtraction films are
routine in cerebral
angiography.
• Small lesions, that are
virtually undetectable
on routine films are
often clearly visible.
• No longer primary
means of
diagnosing
pathological
conditions of the
cerebrovascular
circulatory system
• Its use in
conjunction with
neurovascular
interventional
studies has not
diminished
Conclusion
• Still a very effective
tool in diagnosing
cerebral blood
vessels because it
determines the extent
of vascular
involvement of a
problem
• Can be risky, but its
accuracy and benefits
usually outweigh the
risks making it a
valuable tool