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Outpatient DSA in cerebrovascular disease using transbrachial arch injections
Insights
Intraarterial digital subtraction angiography (DSA) offers a more reliable outpatient evaluation of cerebrovascular disease than intravenous DSA. This improved technique provides clearer images with less contrast, enhancing diagnostic accuracy for both intracranial and extracranial vessels.
Area of Science:
- Neurology
- Radiology
- Vascular Imaging
Background:
- Intravenous digital subtraction angiography (DSA) has limitations in outpatient cerebrovascular disease evaluation.
- Challenges include vessel superimposition, patient motion, and inadequate vascular opacification, hindering definitive diagnoses.
Purpose of the Study:
- To introduce and evaluate an improved intraarterial DSA technique for outpatient cerebrovascular assessment.
- To overcome the limitations of intravenous DSA for clearer and more dependable vascular imaging.
Main Methods:
- Utilized right transbrachial catheterization of the ascending aorta with a specialized catheter.
- Employed small contrast volume injections, pulsed digital image acquisition with multiple projections, and limited postprocedure observation.
- Studied 43 outpatients and 16 inpatients.
Main Results:
- Achieved definitive image quality in 82%-98% of cases, encompassing intracranial and extracranial vessels.
- Reported only two local complications in the total patient cohort.
- Demonstrated reduced contrast load (less than 60% of intravenous DSA) and minimal impact from cardiac output variations.
Conclusions:
- The described intraarterial DSA technique is a safe, convenient, and more effective alternative to intravenous DSA for outpatient cerebrovascular evaluation.
- This method enhances diagnostic clarity and dependability for visualizing complex vascular anatomy.
Abstract:
Experience with intravenous digital subtraction angiography (DSA) has proven disappointing in the outpatient evaluation of cerebrovascular disease. Vessel superimposition, patient motion, and poor vascular opacification all prevent definitive studies in a significant percentage of patients. These problems were addressed by turning to an intraarterial outpatient DSA technique composed of several elements: (1) right transbrachial catheterization of the ascending aorta using a thin, multiple side-hole, straight catheter; (2) arch injections of relatively small volumes of contrast material; (3) pulsed digital image acquisition with multiple projections; and (4) a limited period of postprocedure observation. A total of 43 outpatients and 16 inpatients was studied in this manner with only two complications, both local. Images of definitive quality and completeness were obtained in 82%-98% of cases, and included the major intracranial as well as the extracranial vessels and their circulatory dynamics. Because the iodine load per injection was relatively low, up to 10 angiograms per case were available for delineating superimposed anatomy and motion degradation. Variations in cardiac output had little impact on image quality, and the average case required less than 60% of the contrast load routinely used for intravenous DSA. The transbrachial approach proved as safe and convenient as intravenous DSA but was more thorough and dependable.