Cerebral angiography: what is it and how is it used in neurology?

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

This includes our nervous system, which requires 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 the existence of such damage.

For this reason, 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 cerebral angiography.

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What is a cerebral angiography?

Cerebral angiography is a medical evaluation 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 cerebral blood vessels the flow and state of the circulatory system. The images obtained are generally very clear and make it possible to accurately identify alterations in the blood circulation of the brain.

The procedure is as follows: after placing the patient on the X-ray table, he is immobilized head and a sedative is administered while cardiac activity is monitored. After that, the patient is inserted a catheter into the arteries of the arm or leg, which will be guided through the artery to the neck with the help of X-rays. Once there, a contrast solution is injected through the catheter to later take images of the blood circulation using X-rays. After that, and unless some type of intervention has to be carried out through it, the catheter and proceed to apply pressure to the area through which it has been inserted in order to avoid bleeding.

Although it is generally used as a technique for the diagnosis and monitoring of cerebrovascular disorders, the fact that a catheter is used to perform it In addition, it allows the use of therapeutic procedures such as drug delivery, which can avoid the need for other treatments.

Guys

Cerebral angiography is a technique that has several variants depending on the mechanisms used to assess the state 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 previously explained procedure, in which the catheter is placed in the artery and guided to its objective. It is an invasive procedure that is usually the most common due to its effectiveness and the high level of sharpness it allows. The catheter is usually introduced via the femoral route, through the groin to the aortic arch, where after a first contrast injection proceeds to place the catheter in the artery that is required analyze.

With regard to digital subtraction, it refers to the fact that frequently in x-rays the digitally the skull of the image taken, so that the image of the vessels can be seen more clearly sanguine.

2. Helical computed tomography angiography

In this case, no type of catheter is inserted into the subject's body, but it does require the injection of contrast in order to obtain the image by CT. It is less invasive than its conventional counterpart.

3. magnetic resonance angiography

In this type of angiography, no catheter is used either, and it is not an invasive technique. It involves performing an MRI, not using radiation as in other cases.

What does it allow to diagnose?

Cerebral angiography is a test that even today it is used as one of the main ones to observe the circulatory flow and the state of the blood vessels of the brain. There are multiple disorders and diseases that the application of this technique allows to observe.

1. Cerebrovascular accidents or strokes

Angiography makes it possible to observe the existence of extravasation and rupture of blood vessels, or the absence or obstruction of circulation in some area of ​​the brain. It is because of that this is a valid technique both for detecting ischemia and for visualizing cerebral hemorrhages. (More information about strokes).

2. aneurysms

Angiography can be used to detect the presence of aneurysms.bulges in the arterial wall filled with blood and with a relatively weaker wall that can rupture. (More information about aneurysms).

3. tumors

The presence of tumors in the brain tends to cause disturbances in the blood flow of the brain, as well as cause phenomena such as cerebrovascular accidents. For this reason, angiography allows us to observe the presence of abnormalities generated by the presence of tumors. (More information about brain tumors).

4. malformations

The existence of congenital malformations, as occurs in AVM, can also be assessed using this evaluation and diagnosis technique.

5. arterial or venous changes

Through cerebral angiography, it can be observed if the blood vessels of the brain are in good health, if they are inflamed or if disorders such as atherosclerosis are present.

6. Brain death

Cerebral angiography is also used to assess whether or not there is brain death. Specifically, it is evaluated whether or not there is blood flow, observing an absence of irrigation in those cases of brain death.

7. Other disorders

There is the possibility of observing through cerebral angiography the presence of different disorders and diseases apart from those previously mentioned. For example, alterations can be found 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 and does not tend to cause complications., but this does not prevent it from having risks and adverse side effects that can cause alterations of variable severity.

One of the risks arises from the possibility that the patient may be allergic to the applied contrast (usually iodinated). Likewise, this could cause discomfort or even destroy some tissues if it leaks 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, breathing difficulties, vision problems, infection of the route through which the catheter entered, control problems of the limb in which it has been inserted, speech problems or hemiparesis are a sign that there may be some type of complication that needs to be treated quickly.

Finally, special caution is necessary in the case of pregnant or lactating women, since the radiation emitted could be harmful. It can also happen that a tear of the artery is caused that generates some type of bleeding or clots that can clog the vessel, although it is something very rare.

Bibliographic references:

• Camargo, M.; Peralta, A.; Arias, W.; Market, C.; Laguna, Y.; Cuellar, J.; Laforcada, C.; Peace, G.; Duran, J.C.; Aramayo, M.; Fortun, f. & Núñez, H. (s.f.). Cerebrovascular Accident Protocol. Bolivian Society of Neurology.
• Millán, J.M. & Campollo, J. (2000). Diagnostic value of cerebral angiography in confirming brain death. Advantages and disadvantages. Med. Intensive, 24 (3); 135-141. Madrid.
• Daroff, R.B.; Jankovic, J.; Mazziotta, J.C. and Pomeroy S.L. (2016). Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier.