Digital subtraction angiography: its role in diagnosing carotid artery disease. An ECRI technology assessment

When it was introduced in 1979, digital subtraction angiography (DSA) was greeted with open arms as a minimally invasive, relatively inexpensive, ambulatory procedure by which to diagnose carotid artery disease, a major cause of stroke. Although the technology for DSA has diffused quickly through the medical community, DSA using intravenously injected contrast material is gradually being recognized as inadequate either to screen asymptomatic patients for disease or to assess the degree of stenosis and indicate surgery. Recent research efforts are pointing towards a promising future for both the intra-arterial injection of contrast material for DSA examinations and the possibility of performing some conventional angiographic procedures on an outpatient basis. As a result, digital subtraction angiography will continue to play a role in visualizing the carotid arteries. Nevertheless, because the applications of DSA have been shown to be far fewer than expected, it will be vital for any hospital or freestanding center that has not yet invested in such a system to evaluate carefully the level of utilization it can achieve for such a technology.