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Intravenous angiography in brain death: report of 140 patients
1Department of Neuroradiology, Saint Julien University Hospital, Nancy, France.
Insights
Cerebral intravenous digital subtraction angiography (IV DSA) reliably confirms brain death by showing cessation of blood flow. This diagnostic tool is valuable, especially when other tests are inconclusive or to shorten observation periods.
Area of Science:
- Neurology
- Radiology
- Critical Care Medicine
Background:
- Brain death diagnosis requires confirmation of irreversible cessation of all brain function.
- Cerebral angiography is a potential tool for assessing cerebral blood flow in brain death.
- Intravenous digital subtraction angiography (IV DSA) offers a less invasive approach compared to conventional angiography.
Purpose of the Study:
- To evaluate the diagnostic value and experience of using cerebral intravenous digital subtraction angiography (IV DSA) for confirming brain death.
- To analyze angiographic findings of the vertebrobasilar system in patients with clinical signs of brain death.
Main Methods:
- A study of 140 patients presenting with clinical signs of brain death.
- Cerebral IV DSA was performed on all patients to assess cerebral circulation.
- Patients were categorized into four groups based on the angiographic appearance of the vertebrobasilar system.
Main Results:
- Consistent cessation of blood flow within the internal carotid arteries and their branches was observed in all patients.
- Nine patients exhibited persistent blood flow within the posterior fossa, requiring specific attention.
- IV DSA demonstrated a reliable cessation of cerebral blood flow, confirming brain death.
Conclusions:
- Cerebral IV DSA is a reliable method for confirming brain death.
- Its findings, particularly the cessation of blood flow, are crucial for diagnosis.
- Consideration of transcranial Doppler can optimize the timing of IV DSA in specific clinical scenarios.
Abstract:
We present our experience and discuss the value of cerebral intravenous digital subtraction angiography (IV DSA) in the diagnosis of brain death. A total of 140 patients presenting with clinical signs of brain death were studied by IV DSA. According to the angiographic appearance of the vertebrobasilar system, the patients were divided into four groups. Cessation of blood flow within the internal carotid arteries and their branches was consistently found. Attention is focused on 9 patients with persistent blood flow within the posterior fossa. In sedated patients in whom EEG and evoked brain-stem responses are non-diagnostic, or in order to shorten the observation time, transcranial Doppler should be performed to determine the appropriate moment for IV DSA, which is a reliable method of confirming brain death.