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[Outpatient transbrachial arterial DSA using a 4F catheter for the clarification of extracranial vascular processes]
1Strahleninstitut der Städtischen Kliniken Darmstadt.
Insights
Transbrachial intra-arterial digital subtraction angiography (DSA) offers a safe and effective outpatient method for evaluating cerebrovascular disease. This minimally invasive technique provides reliable imaging, overcoming limitations of intravenous DSA.
Area of Science:
- Vascular Imaging
- Neurology
- Interventional Radiology
Background:
- Intravenous digital subtraction angiography (DSA) often yields suboptimal results for outpatient cerebrovascular evaluations due to issues like motion and poor opacification.
- Limitations of current intravenous DSA necessitate safer, more reliable alternatives for diagnosing cerebrovascular conditions in outpatients.
Purpose of the Study:
- To prospectively assess the safety and efficacy of nonselective intra-arterial DSA via a brachial artery approach in an outpatient setting.
- To evaluate complication rates and diagnostic quality of transbrachial intra-arterial DSA for cerebrovascular disease assessment.
Main Methods:
- 103 patients underwent percutaneous transbrachial intra-arterial DSA using a 4F pigtail catheter for contrast injection into the aorta.
- Complications were prospectively monitored, with a focus on neurovascular and local arterial events.
- Image quality was assessed for diagnostic adequacy.
Main Results:
- Excellent or good image quality was achieved in nearly all examinations.
- No permanent neurovascular complications or surgical interventions for local artery complications (e.g., thrombosis) were reported.
- Only minor complications were observed during the study period.
Conclusions:
- Transbrachial intra-arterial DSA is a safe, simple, and well-tolerated outpatient procedure for cerebrovascular studies.
- This technique provides reliable and complete diagnostic information, addressing the limitations of intravenous DSA in outpatient settings.
Abstract:
Experience with intravenous digital subtraction angiography (DSA) has proven disappointing in the outpatient evaluation of cerebrovascular disease. Variations in cardiac output, vessel superimposition, patient motion and poor vascular opacification frequently combine to produce nondiagnostic examinations. To assess the safety of nonselective intra-arterial DSA performed from a brachial artery approach, the complications of 103 examinations, most of which (85%) were performed on outpatients, were prospectively studied. The injection of contrast material into the aorta was made through a 4F multiple side-hole pigtail catheter, inserted percutaneously from the brachial artery. Images were good or excellent in nearly all cases. No permanent neurovascular complications or local artery complications such as thrombosis requiring surgery were encountered and only a few minor complications occurred. We believe that transbrachial intraarterial DSA is a safe, simple and well-tolerated out-patient procedure that can yield reliable, definitive, and complete cerebrovascular studies in nearly all patients referred for the examination.