Introduction to cerebral angiography DSA, one article!

The operation of cerebrovascular DSA and the judgment of the location and degree of diseased blood vessels have become the basic skills necessary for neurologists. How to quickly get started with cerebrovascular DSA?

The director starts from the two aspects of operation and film reading, please keep these 3 points in mind

Point 1: Should metformin be stopped before and after contrast?

◆ Normal renal function: Do not stop using it before contrast medium, but stop using it for 48~72 hours after using contrast medium, and continue to use it after reexamination of normal renal function.

◆ Abnormal renal function: the use of contrast medium should be suspended 48 hours before use, and the drug should be stopped for 48~72 hours after that, and can continue to be used after the reexamination of renal function is normal.

Point 2: Femoral artery puncture site

◆ Summary in one table: comparison of 4 major puncture points

(Look at the diagram first, then the text)

The puncture point is 1-2 cm below the strongest point ofthe femoral artery pulse. Mark the anterior superior iliac spine and the pubictubercle, the line connecting the two is the inguinal ligament. Mark thedirection of the femoral artery pulse, and insert the needle along thedirection of the femoral artery.

❗️Some doctors use the inguinalskin fold as the standard point for puncture, but this point will changegreatly with the patient's fat or thin, and it is not a constant puncturepoint.

❗️The inguinal ligament is theupper line of femoral artery puncture, do not exceed this line, otherwise therisk of peritoneal hematoma will increase.

Point 3: Can’t analyze specific patients?

A 7-year-old boy was admitted to the hospital because of"prolific phlegm and hoarseness for 2 months, dysphagia and weakness ofthe right limb that gradually worsened for 1 month". Physical examination:the muscle strength of the right limb was grade 3.

Imaging studies were as follows: CT showed a large circularspace-occupying mass in the brainstem, and enhanced MRI revealed that thelesion had a flow-cavity effect, and a giant aneurysm was initially considered.DSA angiography further confirmed the diagnosis of a giant aneurysm at thejunction of the terminal left vertebral artery and the basilar artery.

First of all, it is necessary to grasp the overall cerebralblood flow, especially the collateral circulation, so a balloon occlusionexperiment was performed, and the left vertebral artery was occluded with aballoon, and then the left and right internal carotid arteries could be seenafter angiography

◆ Left internal carotid arteryangiography: the posterior communicating artery is small and only slightlysupplies blood to the posterior cerebral artery.

◆ Right internal carotid arteryangiography: the posterior communicating artery is relatively thick, it canfill the basilar artery and its branches retrogradely, and the aneurysm can beseen in retrograde imaging. In addition, the right vertebral artery was smallon angiography, and the distal end was also occluded.