Cerebral angiography of cerebral vessels what. Carrying out angiography of cerebral vessels

Poor blood circulation in the brain is a common problem among people different ages. Constant stress, poor environment, lack of a normal diet and other factors negatively affect work of cardio-vascular system. Not only are they affected internal organs, but also neural network. Angiography of cerebral vessels will help recognize these problems. This medical research necessary to assess the condition of the arteries, vessels and veins of the brain.

Next, we will look at what angiography is, how it is performed, when doctors resort to it, and what contraindications exist for it. Angiography of cerebral vessels is a method of studying arteries, veins, and vessels, allowing one to detect places of their blockage, narrowing, dilatation, tumor processes, bleeding, various diseases

undetectable by other means. To conduct the study, contrast is injected into the blood and fluoroscopy begins immediately. To perform cerebral angiography, X-ray angiography rooms are used. They are completely sterile and equipped with:
high-speed fluorography cameras;
multi-camera video recording devices;

angiographers.

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

When is angiography performed?

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

Cerebral angiography allows you to identify the location, degree and prevalence of disorders in the vessels, analyze the quality of blood circulation in the bypass vascular pathways, and the quality of the outflow of venous blood.

Using this diagnosis, it is possible to prevent the development of acute circulatory disorders inside the brain and save patients from ischemia and hemorrhages. Angiography of cerebral vessels is performed if there is a suspicion of local displacement of the vessels or the presence of neoplasms in them. Using this diagnosis, tumors are detected in the area sphenoid bone

skulls

Benefits of angiography

Compared with magnetic resonance imaging, angiography of intracranial veins and intracranial arteries has the following advantages: helps prevent unreasonable surgical intervention
or serve as a signal for surgical treatment; only this examination allows you to get a clear and clear picture of the structure blood vessels
brain;
requires low doses of radiation that do not affect the patient’s health; allows you to start immediately medical procedures

restoration of the lumens of blood vessels and veins when they narrow.

Contraindications to the procedure

MR angiography of the neck arteries and cerebral vessels, like other clinical research techniques, is not suitable for everyone. The list of contraindications for this procedure includes:
the presence of various mental disorders in the patient;
extensive swelling and cysts on blood vessels; strong allergic reactions
to contrast agents; cardiac, renal, liver failure
in acute condition;
the presence of metal implants;

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

and complications:
allergic reactions resulting from the interaction of contrast and antiseptic;
severe hemorrhage/bleeding at the catheter insertion site;

myocardial infarction, stroke, sudden development of severe heart disease (less than 1%).

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

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

Features of preparation in cerebral angiography

Before MR angiography of the vessels of the brain and neck, it is necessary to do allergy tests with a contrast agent. Remember that the reaction does not always manifest itself externally in the form of itchy spots and redness. Some people, 10-15 minutes after interacting with the solution, feel dizziness, pain, and coughing attacks. If you notice such symptoms, then you should refuse to study intracranial arteries using angiography.

In this case, the doctor will refer you for a magnetic resonance examination to rule out the use of contrast and the occurrence of associated complications. The next step in preparing for angiography of the neck vessels will be taking tests. They take from the subject general analysis blood, general urinalysis, Rh factor and blood group are determined. Biochemical and clinical examination

blood. When preparing for cerebral angiography, you should avoid eating for 8 hours. The person being examined can continue to take the medications prescribed by the doctor, but the use of blood thinning drugs must be reported in advance. Before starting the procedure, you need to remove all metal objects near the area being examined. Removable dentures, pendants and pendants must remain in the room. Also, ordinary clothing is replaced with a special medical gown.

How is angiography performed?

Angiography of intracranial vessels begins with catheterization/puncture of the selected artery. This will be the vertebral or carotid artery. To study all the veins and vessels of the head, an aortic puncture is performed. An alternative to this method is catheterization. It includes the following steps:
the peripheral artery is punctured (ulnar, subclavian, femoral, brachial);
a catheter is inserted through the resulting hole and led to the mouth of the carotid/vertebral artery;

if you need to study the vessels of the neck and brain in detail, the catheter is inserted into the aortic arch. The catheter is inserted under. The progress of the tube through the vessel is monitored using X-ray television. The vessel itself is not anesthetized, because its inner wall does not contain pain receptors. Once the catheter is brought to the desired point, a contrast agent is injected. It transmits X-rays poorly, so the accuracy of the results of such a study is slightly higher than that of a conventional MRI.

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

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

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

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

During direct carotid angiography, catheterization is performed carotid artery.

The patient is laid down, the head is turned in the opposite side and throw it back. The puncture point is determined by the pulsation of the carotid artery - it is located between top level 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.

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.
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 site of the branch of the vertebral artery.
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 flow contrast agent should be done more slowly.

Femoral or radial artery catheterization

More often selective angiography carry out 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:

Prepare the puncture site.
The femoral artery in the medial third of the inguinal ligament or the radial artery in its distal segment is palpated.
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:

An angiographic needle punctures the skin at an acute angle.
Move the needle forward until the artery pulsates.
They pierce the artery with a sharp push, trying not to damage its opposite wall.
After a stream of blood appears, a conductor is inserted into the needle, secured, and the needle is removed.
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.
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.

Ionic ones can provoke an allergic reaction, causing an increase in the osmotic concentration of blood plasma.
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. At the 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 discomfort- 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 surgical methods of diagnosis and treatment.

The angiographic installation consists of the following complex:

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

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

If symptoms of cerebral vasospasm appear, treatment should be started as soon as possible. Papaverine tablets cause vasodilation 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.

With computed tomographic angiography in circulatory system The patient is injected with a radiopaque substance and a series of layer-by-layer X-rays are taken.

Then, using a special computer program carry out 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 interpreted correctly only after careful study received images and comparison with 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:

For 100 g of honey, take one lemon and one head of garlic, chop using a blender or meat grinder, leave in dark place in a week. Use 1 tbsp. l. twice a day.
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.
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!

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 diagnostic methods vascular pathology. It is part of a group of high-tech procedures that are performed using modern equipment that emits X-rays. They take her to specialized centers 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 conventional x-ray examination of bones or 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 others soft fabrics

(skin, muscles, tendons, etc.) 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 a pathology in it, but also to detail important: 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, which 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 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 to internal organs (intestinal, renal); carotid and other arteries of the neck; arteries of the upper extremities.
Vascular surgery	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:

The subject lies on his back on a special angiography table.
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 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 – invasive method diagnostics, since during its implementation the integrity of tissues is violated - large arteries. 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:

Complete examination: general and biochemical tests blood and urine, 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:

Allergy to iodine.
Heavy general state patient due to incurable or decompensated chronic diseases(hepatorenal, cardiac, pulmonary failure, oncopathology).
Acute inflammatory, suppurative and infectious diseases.
Thrombophlebitis, if contrasting of veins (phlebography) is necessary.
Expressed mental disorders.
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 is a reliable, highly informative modern method for diagnosing vascular diseases. Despite existing risks and opportunity dangerous complications, at correct assessment indications, contraindications and compliance with the technique, in 95–98% the study does not cause any negative consequences.

Cerebral angiography involves the use of radiopaque contrast agents to obtain images of cerebral vessels. The contrast agent is usually injected into the femoral, carotid, or brachial artery. Most often, the femoral artery is punctured, since this allows contrasting 4 vessels at once: 2 carotid and 2 vertebral arteries. The study is indicated in cases where the results of CT and magnetic resonance imaging (MRI) of the brain, magnetic resonance angiography or spinal puncture suggest damage to the cerebral vessels.

Target

Diagnose damage to cerebral vessels, including aneurysms, arteriovenous malformations, thrombosis, narrowing, occlusion.
Identify vascular spasm and displacement caused by intracranial tumor, hematoma, cerebral edema, herniation of its structures, increased ICP or hydrocephalus.
To evaluate the localization of clips applied to the cerebral vessels during surgery and the condition of the vessels themselves in the postoperative period.

Preparation

The patient should be explained that the study will evaluate cerebral blood flow.
The patient must know who will perform the angiography and where, and what it involves.
You should not eat food 8-10 hours before the test.
It is necessary to make sure that the medical history contains all the test results that allow one to judge the state of the blood coagulation system and kidney function.
Before the study begins, the patient must put on a surgical gown, remove jewelry and dentures, remove hairpins, and remove all other metal objects from the radiation area.
If necessary, 30-45 minutes before angiography, the patient is prescribed sedatives and m-anticholinergics.
The patient must urinate before leaving the room.
The patient is explained that he will be placed on the x-ray table and his head will be fixed and that he will have to lie still until the end of the examination.
The patient should be warned that the examination is carried out under local anesthesia (in some cases, for example in children, the examination is carried out under anesthesia).
It should also be noted that during the administration of contrast agent to a short time There may be a burning sensation, a feeling of warmth, facial flushing, headache, salty or metallic taste in the mouth, and after its administration - nausea and vomiting.
It is necessary to ensure that the patient or his relatives give written consent to the study.

Warning. It is necessary to find out if the patient is allergic to iodine, iodine-containing products (for example, shellfish) or radiopaque agents. All cases of an allergic reaction should be noted in the medical history.

Equipment

Contrast agent, automatic injector for administering contrast agent; an X-ray machine that allows you to take serial images in 2 projections, needles for puncture of the artery (18- or 19-gauge 6.25 cm long for adults and 20-gauge 3.75 cm long for children), arterial catheters (for insertion contrast agent into the femoral artery).

Procedure and aftercare

The patient is placed on the X-ray table with his arms extended along his body and asked to remain in this position until the end of the study.
The hair over the site of the intended artery puncture is shaved off, and the skin is treated with alcohol or povidone iodine.
After execution local anesthesia the artery is punctured with a needle and catheterized.
When catheterizing the femoral artery, the catheter is advanced to the aortic arch.
When puncturing the brachial artery (performed less frequently), the tonometer cuff is applied distally and inflated, this prevents the flow of contrast material into the vessels of the forearm and hand.
After the location of the needle or catheter is determined using radiography or fluoroscopy, a contrast agent is injected. For the purpose of timely detection adverse reactions(urticaria, skin flushing or angioedema) the patient is constantly monitored.
Images are taken in lateral and anteroposterior projections, developed and analyzed. If necessary, an additional dose of contrast agent is administered and a new series of radiographs is taken.
During the study, the arterial catheter is rinsed continuously or periodically and vital signs are monitored. important indicators, paying attention to the appearance of signs of neurological disorders.
After obtaining informative radiographs, the catheter or needle is removed. The puncture site of the vessel is pressed with a tampon for 15 minutes.
After completing the study, you should make sure that bleeding has stopped, that there is a pulse in the peripheral arteries, and apply a pressure bandage.
As a rule, the patient should maintain bed rest within 6-8 hours. He is prescribed painkillers, vital signs are monitored for 6 hours and neurological status. Usually the patient can be discharged from the hospital the same day.
Before discharge, the arterial puncture site is examined, and if signs of blood leakage into the surrounding tissues (redness, swelling) are detected, an ice bag is applied. If bleeding develops, bandage the bandage tighter (or apply a pressure bandage again if it has already been removed) and immediately inform the doctor.
After catheterization of the femoral artery, the leg should not be bent for more than 6 hours; it is necessary to regularly feel the pulse in the peripheral arteries (popliteal artery, dorsal artery of the foot) and evaluate the temperature, color and sensitivity of the skin of the limb. This is due to the fact that thrombosis of the artery or compression by a hematoma can prevent its normal blood supply.
It is necessary to monitor the appearance of confusion, weakness and numbness of the extremities (signs of thrombosis and hematoma development), as well as symptoms transient disorder cerebral circulation (due to spasm of the cerebral arteries).
In the case of brachial artery puncture, the arm is immobilized for at least 6 hours and the pulse on the radial artery is regularly determined.
A reminder should be posted near the patient's bedside to alert medical personnel not to take blood pressure readings on the affected arm.
The hand is examined regularly, assessing skin color, temperature and sensitivity. If the hand becomes pale, cold, or the patient complains of numbness, inform the doctor immediately.
After the study, the patient can return to a normal diet. He should drink more fluids, as this will help the contrast agent clear out faster.

Precautionary measures

Cerebral angiography is contraindicated in patients with diseases of the liver, kidneys and thyroid gland.
The study is also contraindicated in case of intolerance to iodine and radiocontrast agents.
If the patient receives daily aspirin or anticoagulants, it is necessary to especially carefully apply a pressure bandage to the site of arterial puncture. In some cases, anticoagulants must be stopped 3 days before the test.

Warning. The puncture site must be regularly examined for timely detection of hematoma or bleeding. If these complications develop, you should immediately notify your doctor.

Normal picture

During the arterial phase of angiography, superficial and deep are contrasted cerebral arteries and arterioles, during the venous phase - superficial and deep veins. With a normal (symmetrical) vascular pattern, the results are assessed taking into account the anamnesis and clinical picture.

Deviation from the norm

Changes in the diameter and lumen of the vessel may be due to its spasm, the presence atherosclerotic plaque, arteriovenous fistula, arteriovenous malformation or arteriosclerosis. Depletion of blood flow may be a consequence of the development of ICH. The displacement of blood vessels allows one to judge the presence of a tumor or edema of the brain, the size of a space-occupying lesion, or a violation of the outflow of cerebrospinal fluid. Cerebral angiography allows you to obtain an image of the vessels supplying the tumor and clarify its location and origin. By changes in the architecture of the branches of the external carotid artery, one can judge the presence of extracerebral tumors, most often meningioma, which can be located both outside and within the cerebral hemispheres.

Factors influencing the result of the study

Head displacement during the study ( poor quality pictures).
Inability to remove metal objects from the irradiation zone (poor image quality).

B.H. Titova

"Cerebral angiography" and others

In diseases caused by malfunction of cerebral vessels, there is a need to conduct an accurate diagnosis in order to prescribe drug treatment or spend surgery. Angiography is a modern examination method that helps to examine pathology without causing harm to the patient.

What is angiography

It is difficult to see the vessels if you just do X-ray. The peculiarity of angiography is that a special contrast agent is introduced, with the help of which, during radiographic review, it is possible to see changes in the images. The technique helps to identify:

tumors;
pathologies of arteries and veins;
phases of cerebral circulation;
tissue diseases.

When performing angiography of cerebral vessels, contrast agents are applied to the carotid or vertebral artery. The preparations contain iodine. They should be used with caution in patients who are allergic to it. It is necessary to pay close attention to nephrotoxicity - the damaging effect of the drug on the kidneys. Contrast agents are used for examination:

Verografin;
Cardiotrust;
Urografin;
Hypak;
Triiodtrust.

Indications for the purpose of the study

Angiography of the brain is used to determine pathologies, diagnose diseases, and plan operations. This method is prescribed in the following cases:

suspected tumor;
frequent loss of consciousness;
venous sinus thrombosis;
stenosis (narrowing) of blood vessels;
embolism of cerebral arteries;
cerebral atherosclerosis;
vascular aneurysms;
lingering headache;
frequent dizziness.

Are there any contraindications

Angiography has contraindications depending on the method used. There are restrictions that are the same for all methods:

pregnancy;
mental disorders;
lactation;
thyroid pathology;
kidney failure;
allergy to iodine;
heart failure;
diabetes;
poor blood clotting;
obesity (the patient does not fit into the device).

Contraindicated for classical method and computed tomography is prohibited from x-ray exposure. Magnetic resonance angiography may have limitations due to the use of a magnetic field. These include:

implant driver heart rate;
claustrophobia;
electronic ear implants;
metal parts in the body - plates, joints.

Methods of conducting the examination

When performing angiography, a contrast agent is supplied through a puncture needle or a catheter is brought to the desired vascular bed. Then the examination begins. Angiography is classified according to the location of contrast:

general - contrast is supplied through a catheter into the chest or abdominal aorta;
selective - the substance is injected into the cerebral vessels;
superselective - contrast is applied through a catheter to the thinnest branches of the vascular bed.

There are several ways to perform angiography of cerebral vessels, which differ in the imaging technique. Each has its own characteristics and is prescribed by specialists in accordance with the patient’s indications and the required amount of information. For examination use classic way– an X-ray of the brain is taken after contrast is administered, and pathologies are identified using a series of images.

Modern angiography techniques are more informative:

CT scan cerebral vessels allows you to take a series of images with a contrast agent on a computed tomograph, followed by 3D visualization of what it will look like big picture;
Magnetic resonance imaging allows examination without contrast, but in special cases it can be used.

CT angiography of cerebral vessels

When performing a computed tomography scan, a contrast agent is injected into a vein in the elbow bend of the arm. This is convenient - there is no surgical intervention, as with puncture. Then layer-by-layer imaging of the brain is performed; the images are processed using special programs into three-dimensional images in which the vessels are clearly visible. The results of the study can show pathologies and serve as information for operations. X-ray radiation during this type of examination is significantly lower than during the classical one.

MR angiography

MRA of cerebral vessels is performed when the patient is allergic to iodine in contrast agents or X-ray irradiation is contraindicated. A magnetic resonance imaging scanner uses a magnetic field. The examination is carried out painlessly. MR angiography of cerebral vessels provides a very accurate diagnosis; as a result of the study, a three-dimensional image is produced, and the condition of the vessels and capillaries is checked.

Other methods

One of the most progressive research methods is MSCT: multislice computed tomography of cerebral vessels. What makes him different is high speed performing a scan. The tube rotates in a spiral around the patient as the table gradually moves. Three-dimensional images are characterized by high clarity. Fluorescein angiography is used to examine the vessels of the retina. A special contrast is injected into a vein, it enters the eye with blood and with special lighting the vessels are visible and pathologies are revealed.

Preparation for the procedure

Before the study, the patient should not eat for 10 hours and not drink for 4 hours. He needs to remove all metal objects. If surgical intervention is required to administer contrast, the following is prescribed:

iodine allergy test;
urine and blood tests;
kidney function testing;
consultations with an anesthesiologist and therapist.

How is the study of the blood vessels of the brain and neck performed?

The examination is carried out in a clinical setting. After preparation and administration of the contrast agent, the patient is placed on the table and a brain scan is performed using special equipment. The resulting image helps to accurately establish the diagnosis so that the attending physician can prescribe therapy or surgery. After examining the vessels of the neck and brain, the patient remains in the hospital for several hours and is then discharged.

Possible complications and consequences after cerebral angiography

Examination of cerebral vessels using angiography may have minor complications. These include:

pain at the site of catheter installation;
allergic reactions to contrast agents;
swelling caused by damage to the artery during puncture;
impaired renal function during contrast removal;
heart failure;
penetration of the contrast agent into surrounding tissues;
stroke - in rare cases.

Two days after an angiographic examination of the veins, vessels and arteries of the brain, the patient will feel confident if he adheres to certain rules. During the first day you need to:

maintain bed rest;
do not remove the bandage;
exclude physical exercise;
not to accept water procedures;
drink more fluids;
no smoking;
abstain from sex;
do not drive.

Where to do and how much does a brain examination cost?

Angiographic examination of cerebral vessels is carried out in clinics where appropriate equipment is available and in medical centers. The cost of procedures in Moscow and in the periphery does not differ much. The price range is:

MRI of arteries – 3500-4600 rubles;
CT angiography – 3200-8000 rubles;
MRI of the brain, arteries and venous sinuses – 7200-11000 rub.