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A practical guide to post-mortem selective cervical angiography in a regional institution
Hulme Kr1, Spark Av2, Liu Htk3
1Northern Forensic Pathology Service Palmerston North, CO Broadway Radiology, 175 Grey St., Palmerston North, 4410, New Zealand. katherineh@medlabcentral.co.nz.
Insights
Post-mortem selective cervical angiography (PM-SCA) aids in examining cervicocerebral arteries, especially the challenging vertebral arteries (VA), when dissection is a suspected cause of death. This technique is time-efficient and adaptable for routine hospital settings.
Area of Science:
- Forensic Pathology
- Vascular Imaging
- Medical Investigation
Background:
- Cervicocerebral dissection syndrome (CDS) necessitates arterial investigation to determine cause of death.
- Proximal common carotid arteries (CCA) are accessible, but vertebral arteries (VA) pose post-mortem (PM) assessment challenges.
- Existing institutional constraints include reliance on general hospital radiology and a 24-hour body release expectation.
Purpose of the Study:
- To describe the indications for post-mortem selective cervical angiography (PM-SCA).
- To detail a time-efficient and flexible PM-SCA method suitable for non-specialized facilities.
- To outline imaging findings and problem-solving strategies for PM-SCA.
Main Methods:
- Selective catheterization and contrast injection into cervical arteries.
- Radiographic visualization of the common carotid arteries (CCA) and vertebral arteries (VA).
- Adaptation of the procedure for limited radiological resources and time constraints.
Main Results:
- PM-SCA successfully visualizes cervicocerebral arteries, including challenging VA.
- The described method is adaptable to general hospital radiology departments.
- The technique addresses the need for rapid assessment within 24-hour body release timelines.
Conclusions:
- PM-SCA is a valuable tool for investigating cervicocerebral dissection syndrome when VA assessment is required.
- The described method offers a practical solution for institutions without dedicated PM radiological facilities.
- This approach enhances post-mortem examination capabilities for vascular pathologies.
Abstract:
When a cervicocerebral dissection syndrome (CDS) is amongst the potential causes of death, investigation of the arteries is required. Whilst the proximal common carotid arteries (CCA) are relatively easy to interrogate at post-mortem (PM), assessment of the vertebral arteries (VA) is more challenging. Post-mortem selective cervical angiography (PM-SCA) provides a method to visualise these arteries to replace or guide further dissection. Our institution does not have dedicated radiological facilities; we are reliant on availability in the general hospital of both equipment and staffing. In addition, there is an expectation of the release of the body within 24 h. Therefore, our methods have to be time-efficient, flexible and suitable for available staff. The current paper aims to describe the indications for the procedure, the method as completed in our institution, imaging findings and problem solving.
