Complete cerebral angiography in the evaluation of patients with cerebrovascular insufficiency

Three hundred and twenty-eight consecutive patients presenting with symptoms of cerebrovascular insufficiency were evaluated with complete cerebral angiography (CCA) under a prospective protocol evaluating the necessity and the utility of CCA over diagnostic modalities confined in their scope to the carotid bifurcation. Procedure mortality was 0.3 per cent (one fatal stroke), major morbidity 0.6 per cent (one non-fatal stroke and one stroke with resolution), and minor morbidity 2.1 percent. Eighteen per cent (60/328) of the CCAs demonstrated highly significant intracerebral pathology that materially affected choice of therapy. CCA was as valuable in evaluating patients with transient ischemic attack, 22 per cent (27/121), as prior stroke, 23 per cent (22/98). CCA is highly useful for the accurate evaluation of associated disease outside the carotid bifurcation, and is therefore essential for accurate delineation of intracerebral anatomy, pathology, and flow patterns. It may be performed with reasonable patient risk, provides information not available from, or of better quality than, real time ultrasound or intravenous digital subtraction angiography, and therefore is essential for the proper selection of procedures, if any is necessary, and the proper order of those procedures.