Cerebral angiography: what is it and what disorders can it detect?

All our organs need the action of the cardiovascular system to survive, because thanks to it they receive the oxygen and nutrients necessary for their subsistence and their proper functioning.

This includes our nervous system, which needs a continuous supply of these elements. But sometimes there may be alterations that damage the vascular system that supplies the brain, or symptoms that suggest such damage exists.

That is why it is necessary to have different techniques that allow us to observe and analyze the blood flow of the brain, being one of the best known is cerebral angiography.

    What is a cerebral angiogram?

    Cerebral angiography is a medical assessment technique that allows the study and analysis of brain flow and the health of the cerebrovascular system. It is a technique in which X-rays are used to visualize by injecting contrast into the major blood vessels of the brain the flow and condition of the circulatory system. The images obtained are generally very sharp and allow precise identification of alterations in the blood circulation of the brain.

    The procedure is as follows: After placing the patient on the x-ray table, his head is immobilized and a sedative is given along with his cardiac activity monitored. After that, the patient is inserted into a catheter in the arteries of the arm or leg, which will be guided through the artery to the neck with the help of x-rays. Injects a contrast solution through the catheter to later take pictures of the bloodstream with the help of x-rays. After that, and unless some type of intervention is to be performed by means of this, the catheter is removed and pressure is applied to the area through which it was inserted to prevent bleeding.

    Although it is generally used as a technique for diagnosing and monitoring cerebrovascular disorders, the fact that a catheter is used to achieve it allows that in addition to such therapeutic procedures such as the delivery of drugs to be used, which can avoid the need. for other treatments.

    type

    Cerebral angiography is a technique that has several variations depending on the mechanisms used to assess the condition of the patient’s blood vessels. Some of the best known are the following.

    1. Conventional angiography (by intra-arterial digital subtraction)

    This is the procedure explained above, in which the catheter is placed in the artery and guided to its goal. It is an invasive procedure which is generally the most common due to its efficiency and the high level of sharpness it allows. The catheter is usually inserted through the femur, through the groin to the aortic arch, where, after a first injection of contrast, the catheter is placed in the artery to be analyzed.

    Regarding digital subtraction, it refers to the fact that frequently X-rays remove the skull from the image taken digitally, so that the image of blood vessels can be more clearly observed.

    2. Helical computed tomography angiography

    In this case, no catheter is inserted into the subject’s body, but it requires the injection of a contrast medium to obtain the CT image. It is less invasive than its conventional counterpart.

    3. Magnetic resonance angiography

    No catheter is used in this type of angiography and it is not an invasive technique. This involves performing an MRI, without using radiation as in other cases.

    What allows you to diagnose?

    Cerebral angiography is a test that still to this day it is used as one of the main ones to observe the circulatory flow and the condition of the blood vessels of the brain. There are many disorders and diseases that the application of this technique allows to observe.

    1. Stroke or cerebrovascular accident

    Angiography allows us to observe the existence of extravasations and ruptures of blood vessels, or the absence or obstruction of circulation in certain areas of the brain. that’s why we are faced with a valid technique both for detecting ischemia and for visualizing cerebral hemorrhages. (Read more on stroke).

    2. Aneurysms

    The use of angiography can detect the presence of aneurysmsLumps of the arterial wall filled with blood and a relatively weaker wall that can break. (More information on aneurysms).

    3. Tumors

    The presence of tumors in the brain tends to cause alterations in cerebral blood flow, In addition to causing phenomena such as stroke. This is why angiography makes it possible to observe the presence of abnormalities generated by the presence of tumors. (Learn more about brain tumors).

    4. Malformations

    The existence of birth defects, such as in AVM, can also be assessed using this assessment and diagnostic technique.

    5. Arterial or venous alterations

    Using cerebral angiography, it can be seen whether the blood vessels in the brain are healthy, inflamed, or have disorders such as atherosclerosis.

    6. Brain death

    Brain angiography is also used to assess whether or not brain death exists. More precisely, it is assessed whether or not there is blood flow, observing an absence of irrigation in cases of brain death.

    7. Other disorders

    There is the possibility of observing by means of the cerebral angiofrafía the presence of different upheavals and diseases in addition to those previously mentioned. For example, they may find alterations in neurosyphilis or in people with disorders such as Kleine-Levine syndrome.

    Risks and possible side effects of this technique

    Cerebral angiography is a generally safe technique that does not tend to cause complicationsBut that does not prevent it from having risks and undesirable side effects that can lead to alterations of varying severity.

    One of the risks is the possibility that the patient is allergic to the applied contrast medium (usually iodine). It could also cause discomfort or even destruction of certain tissue if extravasated out of the vein. It can also be dangerous or harmful for people with kidney problems or diabetes.

    The existence of symptoms such as tingling, difficulty breathing, vision problems, infection of the way the catheter entered, problems controlling the limb into which it was inserted, speech problems or hemiparesis is a sign that there may be some kind of complication that needs to be treated quickly.

    Finally, special caution is necessary in the case of pregnant or breastfeeding women, as the radiation emitted could be harmful. It can also cause an arterial sprain which causes some type of bleeding or clots that can block the vessel, although this is very rare.

    Bibliographical references:

    • Camargo, M .; Peralta, A .; Arias, W .; Mercat, C .; Lagoon, I .; Cuellar, J .; Laforcada, C .; Pau, G .; Durán, JC; Aramayo, M .; Fortún, F. and Núñez, H. (sf). Stroke protocol. Bolivian Society of Neurology.
    • Millán, JM and Campollo, J. (2000). Diagnostic value of cerebral angiography when confirming brain death. Advantages and disadvantages. Med. Intensive, 24 (3); 135-141. Madrid.
    • Daroff, RB; Jankovic, J .; Mazziotta, JC and Pomeroy SL (2016). Bradley’s neurology in clinical practice. 7th ed. Philadelphia, PA: Elsevier.

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