What is angiography of cerebral vessels and how is it done. Types of angiography, indications, stages of the procedure and contraindications Selective cerebral angiography what

Selective cerebral angiography (SCA) is an X-ray method for examining individual sections of the circulatory network of the brain. It is based on the contrasting of vessels with subsequent radiography of the vascular pattern. It is a clarifying diagnosis in cases where the results of CT or MRI suggest damage to the cerebral vessels.

On a note! Selective cerebral angiography allows you to make a correct diagnosis, determine the treatment regimen for cerebral vessels and prescribe effective drugs, determine the methodology and tactics of surgical treatment for vascular pathologies.

Indications for angiography are:

• the need to clarify vascular pathologies;
• suspicion of a neoplasm;
• frequent headaches, dizziness or loss of consciousness;
• suffered a stroke;
• traumatic brain injury;
• epilepsy.

Contraindications

List of contraindications for cerebral angiography:

• kidney failure;
• allergy to iodine-containing drugs;
• blood clotting disorder;
• pregnancy;
• age up to two years;
• myocardial infarction;
• exacerbation of mental illness.

Preparation for SCA

Before angiography, preparation is necessary, including the following steps:

• blood test, mainly for HIV, RW, hepatitis B, C;
• Analysis of urine;
• test for sensitivity to iodine preparations;
• starvation diet for 10 hours before the study;
• taking tranquilizers 12 hours before the study.

SCA methodology

Carotid artery catheterization

With direct carotid angiography, carotid catheterization is performed.

The patient is laid down, the head is turned in the opposite direction and thrown back. The puncture point is determined by the pulsation of the carotid artery - it is located between the upper level of the thyroid cartilage and the inner side of the sternocleidomastoid muscle.

Currently, it is practically not used.

Vertebral artery catheterization

With direct vertebral angiography, catheterization of the vertebral artery can be performed in various ways.

1. Direct puncture of the vertebral artery. An angiographic needle is inserted at the level of the IV-V cervical vertebrae, advanced to their transverse processes, and the vertebral artery is pierced between them.
2. Puncture of the subclavian artery. In the region of the clavicle, the pulsation of the subclavian artery is palpated, it is punctured with a needle, and a catheter is inserted to the branch of the vertebral artery.
3. Puncture of the brachial artery produced in the axilla. A catheter with a side hole and an internal plug is inserted into the lumen of the needle, advanced to the mouth of the vertebral artery. Then a catheter of smaller diameter is inserted through it on a flexible metal string.

Currently, these accesses are practically not used.

It is important! Since the lumen of the vertebral artery is smaller than that of the femoral and carotid arteries, the contrast agent should be delivered more slowly.

Femoral or radial artery catheterization

Most often, selective angiography is performed indirectly. In this case, catheterization of the femoral or radial artery is performed. This method makes it possible to diagnose four arteries at once: two paired carotid and two paired vertebral arteries.

For this:

1. Prepare the puncture site.
2. The femoral artery is palpated in the medial third of the inguinal ligament or the radial artery in its distal segment.
3. After the introduction of the main catheter, it is advanced along the vessel to the aortic arch.

Arterial catheterization technique

During SCA, arterial catheterization is performed according to the following methodology:

1. Angiographic needle pierce the skin at an acute angle.
2. The needle is advanced forward until the artery pulsates.
3. A sharp push pierces the artery, trying not to damage its opposite wall.
4. After the appearance of a jet of blood, a conductor is inserted into the needle, fixed, and the needle is removed.
5. Using a guidewire, a dilator introducer is inserted into the vein. It is necessary for atraumatic placement of the catheter and is equipped with a three-way stopcock to prevent blood loss.
6. The conductor is removed and the catheter is inserted into the introducer lumen.

On a note! The advancement of the catheter along the vascular bed is absolutely painless, since the inner walls of the vessels are devoid of pain receptors.

Use of contrast media

Radiopaque agents are used in angiography to visualize blood vessels.

1. Ionic can provoke an allergic reaction, causing an increase in the osmotic concentration of blood plasma.
2. Non-ionic ones are much safer, but their cost is higher.

Table 1. Iodine-containing contrasts.

One of the obligatory points of preparation for angiography is iodine sensitivity test. It consists in the fact that 2 ml of contrast is slowly injected intravenously and the reaction of the body is observed for three to four hours. At the moment, with the use of modern non-ionic contrasts, this procedure is not required.

The examination is canceled if the following symptoms appear:

• skin redness;
• rash;
• edema;
• nausea and vomiting;
• headache;
• cough;
• suffocation.

Before the introduction of an iodine-containing drug into the catheter, it is heated to body temperature. The rate of administration should be commensurate with the rate of blood flow.

Possible unpleasant sensations - a taste of metal in the mouth, a rush of blood to the face, a feeling of heat throughout the body, especially in the pelvic area.

Remember! All radiopaque agents are nephrotoxic. In case of impaired renal function, strict monitoring of the level of creatinine and urea is necessary.

Tools needed for SCA

For angiography, the following set of tools is used:

• puncture angiographic needle;
• standard Teflon coated conductor;
• introducer-dilator;
• catheter, sometimes of several different diameters.

Angiographic unit

The angiography procedure is carried out in the Department of X-ray Surgery Methods of Diagnosis and Treatment.

The angiographic unit is the following complex:

1. A table that transmits X-rays and moves in a horizontal plane.
2. X-ray tube with image intensifier tube.
3. Image recording and playback system.
4. Monitor.

A series of x-rays is taken in frontal and lateral projections, at a rate of one or more shots per second. Simultaneous recording allows, at the end of the study, to examine each image in detail and to decode it.

Complications

Possible complications after angiography:

1. Allergic reaction to iodine, up to anaphylactic shock.
2. Development of acute renal failure.
3. Angiospasm, fraught with impaired cerebral circulation and stroke.
4. Convulsive attacks.
5. Thrombosis of the artery, as a result of prolonged catheterization.
6. Bleeding at the puncture site.

If symptoms of cerebrovascular spasm appear, treatment should be started as soon as possible. Papaverine tablets cause vasodilation and an increase in blood flow, but they must be taken under medical supervision.

Remember! The main symptoms of angiospasm:

• headache;
• dizziness;
• noise in ears;
• nausea;
• loss of orientation;
• speech disorder.

Other types of angiography

In addition to classical angiography, there are two more methods for its implementation:

• computed tomography (CT) angiography;
• magnetic resonance (MR) angiography.

In computed tomographic angiography, a radiopaque substance is injected into the patient's circulatory system and a series of layered x-rays is taken.

Then, using a special computer program, 3 D-reconstruction of vessels. In this case, the veins and arteries are painted in different colors and a three-dimensional model of their spatial arrangement is obtained.

Magnetic resonance angiography is performed on a magnetic resonance tomograph.

The essence of the method is that the image of the vessels is obtained without the use of radiopaque preparations. Although gadolinium-based contrasts are sometimes used in order to obtain a clearer image.

Table 2. Advantages and disadvantages of various angiography methods.

Deciphering the results of angiographic examination

Cerebral angiography requires the coordinated action of an anesthesiologist, a vascular surgeon and a radiologist.

It is possible to correctly interpret the results only after a thorough study of the obtained images and comparison with the existing symptoms.

Table 3

Folk methods of treating blood vessels

Since most vascular diseases develop as a result of atherosclerosis, cleaning of cerebral vessels at home should be aimed at expanding the lumen, preventing and removing cholesterol plaques.

Some folk recipes for the treatment of blood vessels:

1. For 100 g of honey, take one lemon and one head of garlic, chop with a blender or meat grinder, insist in a dark place for a week. Use 1 tbsp. l. twice a day.
2. Take 5 tbsp. l. rose hips and 10 tbsp. l. hawthorn fruits, chop them, pour two liters of boiling water. Insist overnight in a dark warm place. Take one glass three times a day.
3. Grind 2 tbsp. l. fruits of Japanese Sophora, lower into half a liter of boiling water and boil for 5 minutes. Strain, cool. Take 1/3 cup twice a day.

Remember! Folk remedies are not always completely safe. Therefore, you need to start treatment only after consulting a doctor!

Related entries

With the help of cerebral angiography, an x-ray examination of cerebral circulation is performed in different phases: arterial, capillary and venous.

The procedure is carried out by introducing a contrast agent by catherization or puncture of the artery, followed by x-rays. With the help of cerebral hagiography, the localization of modified vessels and tumors is detected. Such an examination allows you to make an accurate diagnosis in vascular pathology, helps to carry out operations.

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Conducting cerebral angiography

The medulla is supplied with blood from the main arteries:

• sleepy;
• vertebral.

Contrast one of them, often sleepy. As a contrast, water-soluble preparations containing iodine are used:

• hypak;
• triiodtrust;
• urographine;
• verografin;
• cardiotrust;
• triombrast.

X-rays of the head are made in the anteroposterior and lateral projections. The developed images are an angiogram that assesses the state of the cerebral vessels. If necessary, contrast is introduced additionally and a new series of images is taken. The study of the outflow of venous blood is performed using a series of images after the contrast has passed through the tissues. The duration of the procedure is about an hour.

After the study, the patient's condition is monitored for up to 8 hours for the timely detection of complications and their treatment. To accelerate the withdrawal of the contrast agent, drinking plenty of fluids is recommended.

Contraindications:

• allergy to iodine;
• atherosclerosis of cerebral vessels;
• psychical deviations;
• arterial hypertension;
• pregnancy;
• childhood;
• coma;
• kidney failure.

Research Methods

The method of administration of the contrast agent determines the method of diagnosis:

• puncture, when contrast is injected directly into the vessel by puncture;
• catheterization, in which contrast enters through a catheter inserted through a peripheral (femoral) artery along the vascular bed to the desired location.

Cerebral angiography can be:

• general, visualizing all vessels in the brain;
• selective, considering one of the pools: carotid (carotid arteries) or vertebrobasilar (vertebral arteries);
• superselective, exploring the smaller vessel of one of the blood pools.

With the help of superselective angiography, not only the state of the vessels is examined, but also endovascular treatment is carried out. After determining the pathology of a particular vessel, a microsurgical operation is performed:

• removal of arterial-venous malformation;
• clipping of the aneurysm;
• anastomosis.



Indications for research

The patient's complaints of headache, dizziness, tinnitus are an indication for examination by a neurologist, who determines the need for angiography.

Cerebral angiography is necessary to confirm the diagnoses of:

• arterial or arteriovenous aneurysm (damage) of a cerebral vessel;
• arteriovenous malformation (thrombus).

This study determines:

1. 1. The degree of occlusion (blockage) or stenosis (narrowing) of the cerebral vessels, that is, the size of the lumen of the corresponding vessel is set. Thus, the degree of atherosclerotic vascular changes and the need for surgical intervention are determined.
2. 2. When planning an operation to remove a brain tumor, the location of nearby vessels is examined in order to gain access to the operated site.
3. 3. Monitoring the condition of clips previously applied to damaged vessels.



Carrying out coronary angiography of the vessels of the heart - what is it and how is it done?

CT angiography




The CT angiography procedure consists of the following steps:

1. 1. Injection of a contrast agent into the vein of the elbow.
2. 2. Layer-by-layer execution of X-ray images of the brain region, reconstructed by a computer program into three-dimensional images with a clear visualization of blood vessels.

The main advantages of CT angiography:

• no risk from surgery compared to conventional angiography (artery puncture);
• a significant reduction in the radiological load on the body;
• high information content of the image.

The use of spiral computed tomography (SCT) - the latest generation of devices - further increases the information content of the research procedures.

Contraindications for CT angiography:

• diabetes;
• allergy to iodine;
• kidney failure;
• obesity (limitation of the use of a tomograph - weight up to 200 kg);
• pregnancy and lactation;
• thyroid pathology.

MR angiography




With the help of magnetic resonance angiography, the state of the cerebral veins and arteries is visualized with an MRI tomograph, a magnetic field is used instead of X-ray radiation. The advantage of MR angiography is the absence of the destructive effect of X-ray radiation on the body.

MR angiography is performed with or without contrast. This research method is widely used in patients with a contraindication to the introduction of a contrast agent.

Contraindications for MR angiography:

• the presence of metal implants in the body (artificial joints, electronic ear implant, metal plates, hemostatic clips);
• mental disorders;
• claustrophobia;
• obesity;
• pregnancy.

A significant drawback of the technique is the duration of its implementation. The time spent by the patient in the MRI machine is from 20 to 40 minutes.

Angiography of cerebral vessels is an instrumental research method that allows you to literally "see" the vessels of the brain. To conduct a study, it is necessary to introduce a contrast agent into the corresponding vessel of the brain and the presence of an X-ray machine, with which an image of the vessels filled with this contrast will be recorded. Angiography of cerebral vessels is not a routine diagnostic method, it has its own indications and contraindications, as well as, unfortunately, complications. What kind of diagnostic method is this, in what cases it is used, how exactly it is carried out, and you can learn about other nuances of angiography of cerebral vessels from this article.

Angiography in a broad sense is the obtaining of an image of any body vessels using x-rays. Cerebral angiography is just one of the varieties of this extensive research method.

Angiography has been known to medicine for almost 100 years. It was first proposed by the Portuguese neurologist E. Moniz back in 1927. In 1936, angiography was applied in clinical practice, and in Russia the method began to be used since 1954 thanks to the Rostov neurosurgeons V.A. Nikolsky and E.S. Temirov. Despite such a long period of use, cerebral angiography continues to improve to the present.

What is cerebral angiography?

The essence of this research method is as follows. A patient is injected with a radiopaque substance, usually based on iodine (Urografin, Triiodtrast, Omnipaque, Ultravist, and others) into a certain artery of the brain (or the entire network of arteries of the brain). This is done in order to be able to fix the image of the vessel on the X-ray film, since the vessels are poorly visualized in a conventional image. The introduction of a radiopaque substance is possible by puncture of the corresponding vessel (if this is technically feasible) or through a catheter brought to the required vessel from the periphery (usually from the femoral artery). When the contrast agent is in the vascular bed, a series of x-rays is taken in two projections (frontal and lateral). The resulting images are evaluated by a radiologist, he draws conclusions about the presence or absence of a certain pathology of the cerebral vessels.

Varieties

Depending on the method of administration of the drug, this research method can be:

• puncture (when contrast is injected by puncturing the corresponding vessel);
• catheterization (when contrast is delivered through a catheter inserted through the femoral artery and advanced along the vascular bed to the desired location).

According to the vastness of the study area, angiography of cerebral vessels is:

• general (all vessels of the brain are visualized);
• selective (one pool is considered, carotid or vertebrobasilar);
• superselective (a vessel of a smaller caliber is examined in one of the blood pools).

Superselective angiography is used not only as a research method, but also as a method of endovascular treatment, when after determining the “problem” in a particular vessel, this problem is “eliminated” using microsurgical techniques (for example, embolization or thrombosis of an arteriovenous malformation).

Due to the widespread introduction of modern diagnostic methods, such as computed tomography (CT) and magnetic resonance imaging (MRI), CT angiography and MR angiography are increasingly being performed in recent years. These studies are carried out in the presence of appropriate tomographs, they are less traumatic and safer than simple angiography. But more on that later.

Indications for carrying out

Cerebral angiography is a specialized diagnostic method, which should be prescribed only by a doctor. It is not performed at the request of the patient. The main indications are:

• suspicion of arterial or arteriovenous;
• suspicion of arteriovenous malformation;
• determination of the degree of stenosis (narrowing) or occlusion (blockage) of cerebral vessels, that is, the establishment of the lumen of the corresponding vessels. In this case, the severity of atherosclerotic changes in the vessels and the need for subsequent surgical intervention are established;
• establishing the relationship of cerebral vessels with the adjacent one for planning surgical access;
• control of the location of the clips applied to the vessels of the brain.

I would like to note that just complaints of dizziness, headache, tinnitus and the like are not in themselves an indication for angiography. Patients with such symptoms should be examined by a neurologist, and based on the results of the examination, as well as other research methods, the need for angiography is determined. This need is established by the doctor!

Contraindications

The main contraindications are:

• allergic reaction (intolerance) to iodine preparations and other radiopaque substances;
• pregnancy (due to ionizing radiation during the procedure). In this case, it is possible to perform MR angiography;
• mental illness that does not allow you to comply with all the conditions for the procedure (for example, a person cannot help but move during the picture);
• acute infectious and inflammatory diseases (since the risk of complications increases);
• violation of the indicators of the blood coagulation system (both downward and upward);
• the general condition of the patient, regarded as severe (this may be heart failure of the III degree, end-stage renal and hepatic insufficiency, coma, and so on). In essence, this subgroup of contraindications is relative.

Preparation for angiography

To obtain accurate results and reduce the risk of complications from the procedure, it is recommended:

• pass a general and biochemical blood test, including - to determine the indicators of the coagulation system (the statute of limitations for tests should not exceed 5 days). The blood type and Rh factor are also determined in case of possible complications;
• make an ECG and FG (FG, if one has not been carried out within the last year);
• within 14 days do not drink alcoholic beverages;
• during the last week do not take drugs that affect blood clotting;
• perform an allergy test with a contrast agent. To do this, 0.1 ml of the corresponding drug is administered intravenously to the patient for 1-2 days and the reaction is evaluated (appearance of itching, rash, difficulty breathing, etc.). In the event of a reaction, the procedure is contraindicated!
• the day before, take antihistamine (antiallergic) drugs and tranquilizers (if necessary and only as directed by a doctor!);
• do not eat for 8 hours and do not drink water 4 hours before the study;
• swim and shave (if necessary) the site of puncture or catheterization of the vessel;
• before the examination itself, remove all metal objects (hairpins, jewelry).

Research technique

At the very beginning, the patient signs consent to conduct this type of study. The patient is placed with an intravenous peripheral catheter to have instant access to the circulatory system. Then premedication is carried out (approximately 20-30 minutes before the procedure): antihistamines, tranquilizers, painkillers are administered to minimize discomfort during the procedure and the risk of complications.

The patient is placed on the table and connected to the devices (heart monitor, pulse oximeter). After treating the skin with a local anesthetic and anesthesia, the corresponding vessel (carotid or vertebral artery) is punctured. Since it is not always possible to accurately enter these arteries, a small skin incision and a puncture of the femoral artery are most often performed, followed by immersion of the catheter and passing it through the vessels to the study site. The advancement of the catheter along the arterial bed is not accompanied by pain, since the inner wall of the vessels is devoid of pain receptors. The advancement of the catheter is monitored by x-ray. When the catheter is brought to the mouth of the required vessel, a contrast agent preheated to body temperature is injected through it in a volume of 8-10 ml. The introduction of contrast may be accompanied by the appearance of a metallic taste in the mouth, a feeling of heat, a rush of blood to the face. These sensations pass on their own within a few minutes. After the introduction of contrast, x-rays are taken in frontal and lateral projections several times almost every second (which allows you to see the arteries, the capillary phase, and the veins). Pictures are developed and immediately evaluated. If something remains incomprehensible to the doctor, an additional portion of the contrast agent is introduced, and the pictures are repeated. Then the catheter is removed, a sterile pressure bandage is applied to the puncture site of the vessel. The patient should be observed by medical staff for at least 6-10 hours.

Complications

According to statistics, complications during this diagnostic method occur in 0.4-3% of cases, that is, not so often. Their occurrence can be associated both with the procedure itself (for example, the outflow of blood from the puncture site of the vessel), and with the use of a contrast agent. It should be borne in mind that compliance with all conditions in the preparation and conduct of angiography is the prevention of possible complications. The use of iodine-containing drugs of the latest generation (Omnipak and Ultravist) is characterized by a lower statistics of complications.

So, the possible complications of angiography of cerebral vessels are:

• vomit;
• an allergic reaction to an iodine-containing drug: itching, swelling and redness at the injection site, and then the appearance of shortness of breath (reflex breathing disorder), a drop in blood pressure, heart rhythm disturbance. In severe cases, anaphylactic shock may develop, which is a life-threatening condition;
• spasm of cerebral vessels and, as a result, acute cerebrovascular accident (up to);
• convulsive seizures;
• penetration of the contrast agent into the soft tissues in the area of ​​the vessel puncture (outside the vascular bed). If the volume of the drug spilled into the tissue is up to 10 ml, then the consequences are minimal, if more, then inflammation of the skin and subcutaneous fat develops;
• outflow of blood from the puncture site of the vessel.

CT and MR angiography: what are the features?

CT and MR angiography of cerebral vessels are inherently a similar study as angiography. But there are a number of some features of these procedures that distinguish them from angiography of cerebral vessels. That's what we'll talk about.

• it is carried out using a tomograph, and not a conventional x-ray machine. The study is also based on x-rays. However, its dose is much less than with conventional angiography of cerebral vessels, which is safer for the patient;
• computer processing of information makes it possible to obtain a three-dimensional image of the vessels at absolutely any point in the study (this applies to the so-called spiral CT angiography performed on a special spiral tomograph);
• the contrast agent is injected into the vein of the elbow bend, and not into the arterial network (which significantly reduces the risk of complications, since the administration of the drug becomes a conventional intravenous injection through a peripheral catheter).
• there is a weight limit for CT angiography. Most scanners can withstand body weight up to 200 kg;
• the procedure is performed on an outpatient basis and does not require monitoring of the patient at the end of it.

MR angiography is characterized by the following features:

• it is carried out using a magnetic resonance tomograph, that is, the method is based on the phenomenon of nuclear magnetic resonance. This means that there is no X-ray radiation during the procedure (and therefore MR angiography is allowed during pregnancy);
• can be carried out both with the use of a contrast agent (for better visualization) and without it (for example, with intolerance to iodine preparations in patients). This nuance is undeniable
  advantage over other types of angiography. If necessary, the use of contrast, the substance is also injected into the vein of the elbow bend through a peripheral catheter;
• the image of the vessels is obtained three-dimensional due to computer processing;
• a series of images takes a slightly longer period of time compared to other types of angiography, while the person needs to lie in the tube of the tomograph all the time. For those suffering from claustrophobia (fear of closed spaces), this is not feasible;
• the procedure is contraindicated in the presence of an artificial pacemaker, metal clips on vessels, artificial joints, electronic inner ear implants);
• is carried out on an outpatient basis, and the patient is immediately released home.

In general, we can say that CT and MR angiography are modern, less dangerous and more informative research methods than conventional angiography of cerebral vessels. However, they are not always feasible, so conventional angiography of cerebral vessels is still a relevant method for studying cerebral vascular pathology.

Thus, angiography of cerebral vessels is a very informative method for diagnosing mainly vascular diseases of the brain, including stenosis and occlusion, which are the cause of strokes. The method itself is quite affordable, it requires only the presence of an X-ray machine and a contrast agent. Subject to all the conditions for the preparation and conduct of the study, angiography of cerebral vessels gives an accurate answer to the question posed to it with a minimum number of complications. In addition, modern medicine has such innovative methods as CT and MR angiography, which are slower, less harmful and traumatic for the patient. CT and MR angiography allow you to get a three-dimensional image of the vessels, and therefore, with a greater degree of probability, do not miss the existing pathology.

Medical animation on the topic "Cerebral angiography":

From this article you will learn: what angiography is, what it is intended for, and in the diagnosis of which diseases you cannot do without it. What types of angiography exist, how dangerous are they, and which one is the best. How is the study going and how to prepare for it. What specialists carry out such diagnostics, where it can be done and how to decipher the results.

Article publication date: 04/04/2017

Article last updated: 05/29/2019

Angiography is a method of X-ray contrast diagnostics of vascular diseases. It allows you to see and study the vessels of any part of the human body (head, limbs, heart, etc.) and evaluate:

• The presence of normal and accessory arteries, how and where they are located.
• How well their lumen is preserved, and whether there are narrowings (stenosis) or expansions (aneurysms) that impair patency.
• The structure and integrity of the vascular wall.
• How well is the blood flow.

Angiography is the most accurate and reliable among all existing methods for diagnosing vascular pathology. It is part of a group of high-tech procedures that are carried out using modern equipment that emits x-rays. It is carried out in specialized centers by angiosurgeons. Indications are established by doctors of different specialties, which depends on the type of vascular disorders - cardiologists, cardiac surgeons, neurologists and neurosurgeons, vascular surgeons and oncologists.

Equipment for angiographic examination

The essence and principle of the method

Angiographic diagnostics allows you to get a visual image (picture) of large and small vessels of the studied anatomical region of the body. Its principle is similar to conventional X-ray examination of bones or chest - X-rays passing through tissues are absorbed by them in different ways, which is displayed on a special film in the form of a silhouette of the structures under study.

But it is not by chance that angiography refers not to general, but to special (contrast) radiological methods. After all, vessels are soft tissue formations, therefore, like other soft tissues (skin, muscles, tendons, etc.), they are not visible on a conventional x-ray. In order for them to become visible to the rays, they need to be contrasted - a vessel is punctured, a catheter is installed in its lumen and filled with an X-ray contrast agent that reflects radiation well.

Thanks to modern digital and computer technologies, it is possible to obtain not only an image of individual vessels filled with a contrast agent, but a picture on film. It is possible to model it in different planes (for example, 3D - three-dimensional) and video recording of the process of filling the entire arterial bed with contrast. This method allows not only to determine whether there is a pathology in it, but also to detail important anatomical features: how and where the vessels pass, how much their lumen and walls are changed, whether there are additional (collateral) blood flow paths.

Types of angiography and their purpose

Depending on which vessels are examined, and with the help of what technologies, angiography can be different. The most common varieties are shown in the table.

Considering the rapid growth of vascular pathology, arteriography of the heart, brain and lower extremities is considered to be the most popular type of angiography. Vessels can be most accurately examined using multislice tomography (computed or magnetic resonance) or digital angiography with 3D imaging technology.

What diseases can be diagnosed - indications for research

Vessels of large, medium and small caliber (diameter from 2–3 cm to 1–2 mm) are available for angiographic examination. This allows using the method for diagnosing pathology accompanied by impaired blood supply to organs and tissues:

• atherosclerosis (narrowing (occlusion) of the lumen by atherosclerotic plaques);
• thrombosis and (complete blockage (obliteration) by blood clots);
• aneurysm and malformation (abnormal expansion with thinning of the wall, threatening to rupture it);
• compression of the artery by the tissues with which it comes into contact;
• tortuous course or abnormal location of the vessel, impeding blood flow through it;
• excessive vascular branching and clusters, which should not be normal, which indicates a tumor process.

The most common pathologies for which angiography is indicated are described in the table.

Depending on the indications and the existing pathology, angiography can be either purely diagnostic or combine diagnostic and therapeutic purposes. This means that during its implementation, if necessary, it is possible to carry out manipulations that eliminate the detected pathology (stenting (expansion of narrowed areas) of the arteries, their embolization (lumen occlusion) in case of wall rupture, hemorrhages and tumors).

How it all happens: the steps of the procedure

Angiography can be performed only in special diagnostic centers equipped with modern equipment. The procedure is represented by the following steps and manipulations:

1. The subject lies on his back on a special table of the angiographic unit.
2. Under conditions of sterility (as in the operating room), the area in which the vessel will be punctured is treated with antiseptics (alcohol, betadine, iodine):

• One of the inguinal-femoral areas (femoral artery) is a universal point from which any vascular pool of the body (cerebral, aortic, coronary, upper and lower extremities) can be filled with contrast.
• The inner surface of the shoulder or forearm (brachial, radial or ulnar artery) - if you need to examine the vessels of the head and upper limbs.

The total duration of an angiography ranges from 10-15 minutes to an hour.

If angiography is performed using magnetic resonance or computed tomography, the procedure may follow the classic algorithm described above, or it may be simplified. In the first case, the study will be the most reliable and informative. A simplified scheme that involves the introduction of a contrast agent not into the artery, but into the cubital vein (like a regular intravenous injection), also makes it possible to study the vessels, but not as accurately as with intra-arterial injection.

How to prepare for the study

Angiography is an invasive diagnostic method, since during its implementation the integrity of tissues - large arteries - is violated. Its additional danger is the need to administer drugs that can cause severe allergic reactions. Therefore, it is imperative to prepare for it. The decision on the need for angiography can only be made by a specialist, comparing the potential benefits and harms of it.

Classical training includes the following rules:

• A full examination: general and biochemical blood and urine tests, coagulogram (clotting), group and Rh factor, blood sugar, markers of viral hepatitis and Wasserman reaction, ECG, and, if necessary, ultrasound of the heart and blood vessels.
• The study is carried out on an empty stomach and after emptying the bladder.
• A week before the procedure, do not drink any alcohol, and also reduce the dose of blood-thinning drugs (Clopidogrel, Warfarin, Aspirin, Heparin) as much as possible or stop taking them altogether (only after consulting a doctor!).
• Tell your doctor if you have any allergic reactions, especially to iodine!
• A few hours before angiography or 1–2 days before it, a test for a radiopaque preparation is performed - 0.1–0.2 ml is injected intravenously. If after the test there are no allergic manifestations (itching, redness, skin rash, shortness of breath, drop in blood pressure, pain in the eyes), the study can be carried out.
• In the morning before the procedure, shave the hair in the area where the artery will be punctured.
• 1-2 hours before the study, you can take anti-allergic and sedative drugs (Loratadine, Gidazepam, etc.) or introduce stronger injections if there are medical indications.

If angiography is performed in an emergency (for example, in case of a heart attack), the preparation time is reduced to a minimum. But it is imperative to comply with the most important rules - determining the reaction to an iodine-containing drug, emptying the stomach and bladder.

Contraindications

The most common contraindications for which angiography should not be performed are:

1. Allergy to iodine.
2. Severe general condition of the patient due to incurable or decompensated chronic diseases (hepatic-renal, heart, pulmonary insufficiency, oncopathology).
3. Acute inflammatory, suppurative and infectious diseases.
4. Thrombophlebitis, if contrasting of the veins (phlebography) is necessary.
5. Pronounced mental disorders.
6. Pregnancy.

The first two contraindications are absolute - the study is impossible. The remaining contraindications may be temporary or relative - if the benefit of the study outweighs its risk.

Angiography is a reliable highly informative modern method for diagnosing vascular diseases. Despite the existing risks and the possibility of dangerous complications, with a correct assessment of indications, contraindications and observance of the technique, the study does not cause any negative consequences in 95-98% of cases.

The technique is used to detect vascular pathology of the brain, identify abnormalities in the development of blood vessels, their excessive tortuosity or loopiness, narrowing of the lumen, blockage, asymmetry in the discharge of vascular branches, aneurysms, vascular malformations. Angiography of the brain allows you to determine the degree, prevalence and localization of vascular disorders, to study the state of blood circulation in the vascular collaterals (bypass vascular pathways), to assess the venous outflow of blood.

Timely diagnosis of vascular pathology makes it possible to prevent the development of acute circulatory disorders - ischemia and hemorrhage. In addition, cerebral angiography is used in the area of ​​the Turkish saddle. The oncological process in the brain tissue is indicated by the local displacement of arteries and veins, the presence of newly formed (growing into the tumor) vessels.

Contraindications

Angiography of the brain has the same general contraindications as any contrast radiography. The method is not used for intolerance to iodine preparations, impaired renal function and thyroid diseases. In addition, one should be aware of the irritating effect of the contrast agent on the vessels of the brain, the likelihood of which increases sharply when the concentration of the drug is exceeded.

Training

First of all, an allergic test with a contrast agent is performed, which involves the introduction of 2 ml of the drug into a vein. If nausea, headache, runny nose, rash or cough occur, angiography is replaced by other methods. The patient must refrain from eating for 8-10 hours before the examination and inform the doctor in advance about taking medications that affect blood clotting. Immediately before the start of the procedure, the patient should remove all metal objects (hairpins, hairpins, jewelry, removable dentures, etc.) from the examination area, put on a special gown.

Methodology

For the introduction of contrast, a puncture of the carotid or vertebral artery is usually performed. To study all the vessels of the brain (panangiography), aortic puncture is performed. An alternative method of introducing a contrast agent is catheterization, in which a peripheral artery (brachial, ulnar, subclavian or femoral) is punctured and a catheter is inserted through it at the mouth of the vertebral or carotid artery, and with panangiography of the head - into the aortic arch. The catheter is a special plastic tube, its introduction is carried out under local anesthesia, and its passage through the vessel is controlled by X-ray television.

When the contrast is injected, the patient may experience a transient sensation of warmth or burning, redness of the face, and a metallic or salty taste in the mouth. After the introduction of the drug, images of the head are taken in the anteroposterior and lateral projections. Angiograms are immediately developed and evaluated, if necessary, an additional contrast agent is injected and a new series of radiographs is performed. Usually this procedure is repeated several times. After passing the contrast through the tissues, a final series of images is taken to study the outflow of venous blood. Then the catheter or puncture needle is removed, and the puncture area is pressed down for 10-15 minutes to stop bleeding.

In most cases, the duration of angiography of cerebral vessels does not exceed one hour. After the examination, the patient should be under medical supervision for 6-8 hours. The specialist periodically examines the puncture site and checks the pulse on the peripheral arteries for the timely detection of possible complications. The patient is recommended to drink plenty of fluids for the speedy removal of the contrast agent from the body. If the examination was carried out by catheterization of the femoral artery, it is necessary to keep the leg in an extended state for 6 hours after the procedure.

Complications

In modern neurology, angiography of cerebral vessels is considered a practically safe diagnostic technique. In rare cases, there is damage to the vessel during puncture or catheterization. At the puncture site, bleeding may begin, a hematoma, redness or swelling may form, and thrombosis is possible. The introduction of a contrast agent is sometimes complicated by nausea, vomiting, and allergic reactions.