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Published on: January 4, 2013
Selective 4 vessels angiography in brain death: a retrospective study
Martin Savard1, Alexis F Turgeon, Jean-Luc Gariépy
1Département des Sciences Neurologiques, Centre Hospitalier Affilié Universitaire de Québec, Hôpital de l'Enfant-Jésus, Université Laval, Québec, Québec, Canada.
Summary
Selective four vessels angiography (S4VA) for brain death (BD) diagnosis showed no venous drainage in 100% of cases. Absence of capillary or venous opacification may be a better marker for cerebral circulatory arrest.
Area of Science:
- Neurology
- Radiology
- Forensic Medicine
Background:
- Ancillary tests like selective four vessels angiography (S4VA) are used in Canadian brain death (BD) diagnosis when clinical exams are inconclusive.
- Current guidelines emphasize absence of superficial arterial flow, disregarding venous return.
- Concerns exist regarding persistent arterial patency in BD patients, necessitating a review of S4VA practices.
Purpose of the Study:
- To investigate the prevalence of intracranial arterial, capillary (parenchymogram), and venous opacification in patients undergoing S4VA for BD determination.
- To evaluate current clinical practices in BD diagnosis using S4VA.
Main Methods:
- Retrospective analysis of S4VA procedures for BD diagnosis between 2003 and 2007.
- Independent review of all S4VA tests by two neuroradiologists.
- Consensus reached to resolve any disagreements.
Main Results:
- Of 32 patients declared BD via S4VA, 28% showed proximal intracranial arterial opacification.
- No instances of cerebral capillary (parenchymogram) or deep venous drainage opacification were observed.
- A 95% confidence interval of 0-10% for capillary and venous opacification was noted.
Conclusions:
- The absence of cerebral deep venous drainage or parenchymogram may serve as a more reliable objective marker for cerebral circulatory arrest in BD diagnosis.
- These findings suggest a need for further research to refine the interpretation of angiographic studies in BD determination.
