Cerebral angiography

Cerebral angiography is a form of angiography which provides images of blood vessels in and around the brain, thereby allowing detection of abnormalities such as arteriovenous malformations and aneurysms. It was pioneered in 1927 by the Portuguese neurologist Egas Moniz at the University of Lisbon, who also helped develop thorotrast for use in the procedure.[1]

Cerebral angiography
Cerebral angiography, arteria vertebralis sinister injection.JPG
Cerebral angiogram showing a transverse projection of the vertebrobasilar and posterior cerebral circulation.

Typically a catheter is inserted into a large artery (such as the femoral artery) and threaded through the circulatory system to the carotid artery, where a contrast agent is injected. A series of radiographs are taken as the contrast agent spreads through the brain's arterial system, then a second series as it reaches the venous system.

For some applications[citation needed] cerebral angiography may yield better images than less invasive methods such as computed tomography angiography and magnetic resonance angiography. In addition, cerebral angiography allows certain treatments to be performed immediately, based on its findings. In recent decades, cerebral angiography has so assumed a therapeutic connotation thanks to the elaboration of endovascular therapeutic techniques. Embolization (a minimally invasive surgical technique) over time has played an increasingly significant role in the multimodal treatment of cerebral MAVs, facilitating subsequent microsurgical or radiosurgical treatment.[2][3] Another type of treatment possible by angiography (if the images reveal an aneurysm) is the introduction of metal coils through the catheter already in place and maneuvered to the site of aneurysm; over time these coils encourage formation of connective tissue at the site, strengthening the vessel walls.[4][5]

In some jurisdictions, cerebral angiography is required to confirm brain death.[citation needed]

Prior to the advent of modern neuroimaging techniques such as MRI and CT in the mid-1970s, cerebral angiographies were frequently employed as a tool to infer the existence and location of certain kinds of lesions and hematomas by looking for secondary vascular displacement caused by the mass effect related to these medical conditions. This use of angiography as an indirect assessment tool is nowadays obsolete as modern non-invasive diagnostic methods are available to image many kinds of primary intracranial abnormalities directly.[6] It is still widely used however for evaluating various types of vascular pathologies within the skull.


Neck extension can help to navigate into tortous cerival part of the internal carotid artery.[7][8] With the catheter in the common carotid artery, the contrast injection rate is 7 to 8 ml/sec with total volume of injection stood at 11 to 12 ml.[9]


Rarely, 0.3 to 1% of the cases experience cortical blindness from 3 minutes to 12 hours after the procedure. It is a condition where those affected experienced loss of vision with normal pupillary light reflex, and normal extraocular muscles movement. The condition can sometimes be accompanied by headaches, mental state changes, and memory losses.[10]


Cerebral angiography was first described by Antonio Caetano de Abreu Freire, Portuguese physician and politician in 1927. He performed this procedure on six patients. Two developed Horner's syndrome due to leaking of contrast material around the carotid artery, one developed temporary aphasia, and another died due to thromboembolism to the anterior circulation of the brain.[11]

Prior to the 1970s the typical technique involved a needle puncture directly into the carotid artery,[12][13] as depicted in the 1973 horror film The Exorcist,[14] which was replaced by the current method of threading a catheter from a distant artery due to common complications caused by trauma to the artery at the puncture site in the neck (particularly hematomas of the neck, with possible compromission of the airway).[15][16]

See alsoEdit


  1. ^ Tondreau RL (November 1985). "The retrospectoscope. Egas Moniz 1874-1955". Radiographics. 5 (6): 994–7. doi:10.1148/radiographics.5.6.3916824. PMID 3916824.
  2. ^ Valavanis A, Yaşargil MG (1998). "The endovascular treatment of brain arteriovenous malformations". Advances and Technical Standards in Neurosurgery. 24: 131–214. doi:10.1007/978-3-7091-6504-1_4. ISBN 978-3-7091-7339-8. PMID 10050213. Cite journal requires |journal= (help)
  3. ^ Negoro M, Miyachi S, Hattori T, Okamoto T, Fukui K, Fukasaku KA, et al. (November 1999). "The selection and result of AVM treatment". Interventional Neuroradiology. 5 (Suppl 1): 167–70. doi:10.1177/15910199990050S130. PMID 20670560. S2CID 27079942.
  4. ^ Söderman M, Andersson T, Karlsson B, Wallace MC, Edner G (June 2003). "Management of patients with brain arteriovenous malformations". European Journal of Radiology. 46 (3): 195–205. doi:10.1016/S0720-048X(03)00091-3. PMID 12758114.
  5. ^ Briganti F, Leone G, Panagiotopoulos K, Marseglia M, Mariniello G, Napoli M, Caranci F (August 2013). "Endovascular treatment of cerebral aneurysms using the hydrocoil embolic system". The Neuroradiology Journal. 26 (4): 420–7. doi:10.1177/197140091302600407. PMC 4202812. PMID 24007730.
  6. ^ Leeds NE, Kieffer SA (November 2000). "Evolution of diagnostic neuroradiology from 1904 to 1999". Radiology. 217 (2): 309–18. doi:10.1148/radiology.217.2.r00nv45309. PMID 11058623. S2CID 14639546.
  7. ^ Takata, Megumu; Fukuda, Hitoshi; Kinosada, Masanori; Miyake, Kosuke; Murao, Kenichi (September 2017). "Use of Simple Neck Extension to Improve Guiding Catheter Accessibility in Tortuous Cervical Internal Carotid Artery for Endovascular Embolization of Intracranial Aneurysm: A Technical Note". World Neurosurgery. 105: 529–533. doi:10.1016/j.wneu.2017.06.023.
  8. ^ Kim, Sang Uk; Sung, Jae Hoon; Lee, Dong Hoon; Yi, Ho Jun; Lee, Hyung-Jin; Yang, Ji-Ho; Lee, Il-Woo (May 2019). "Feasibility of Using Neck Extension to Overcome a Difficult Aortic Arch and Gain Access to the Carotid Artery". World Neurosurgery. 125: e110–e116. doi:10.1016/j.wneu.2018.12.216.
  9. ^ Ahn SH, Prince EA, Dubel GJ (September 2013). "Basic neuroangiography: review of technique and perioperative patient care". Seminars in Interventional Radiology. 30 (3): 225–33. doi:10.1055/s-0033-1353474. PMC 3773070. PMID 24436543.
  10. ^ Saigal, Gaurav; Bhatia, Rita; Bhatia, Sanjiv; Wakhloo, Ajay K. (2004-02-01). "MR Findings of Cortical Blindness Following Cerebral Angiography: Is This Entity Related to Posterior Reversible Leukoencephalopathy?". American Journal of Neuroradiology. 25 (2): 252–256. ISSN 0195-6108. PMID 14970026.
  11. ^ Kaufmann TJ, Kallmes DF (June 2008). "Diagnostic cerebral angiography: archaic and complication-prone or here to stay for another 80 years?". AJR. American Journal of Roentgenology. 190 (6): 1435–7. doi:10.2214/AJR.07.3522. PMID 18492888.
  12. ^ Nii K, Kazekawa K, Onizuka M, Aikawa H, Tsutsumi M, Tomokiyo M, et al. (August 2006). "Direct carotid puncture for the endovascular treatment of anterior circulation aneurysms". AJNR. American Journal of Neuroradiology. 27 (7): 1502–4. PMC 7977554. PMID 16908568. Retrieved 2018-03-20.
  13. ^ Ross IB, Luzardo GD (February 2006). "Direct access to the carotid circulation by cut down for endovascular neuro-interventions". Surgical Neurology. 65 (2): 207–11, discussion 211. doi:10.1016/j.surneu.2005.06.023. PMID 16427431.
  14. ^ Harrigan MR, Deveikis JP (April 20, 2009). Handbook of Cerebrovascular Disease and Neurointerventional Technique. Springer Science & Business Media. p. 88. ISBN 978-1-60327-125-7. Retrieved February 23, 2019.
  15. ^ Taha MM, Sakaida H, Asakura F, Maeda M, Toma N, Sano T, et al. (October 2007). "Access site complications with carotid angioplasty and stenting". Surgical Neurology. 68 (4): 431–7. doi:10.1016/j.surneu.2006.11.036. PMID 17905068.
  16. ^ Palmer FJ (March 1975). "Carotid angiography by direct needle puncture:an obsolete technique?". Australasian Radiology. 19 (1): 26–31. doi:10.1111/j.1440-1673.1975.tb01915.x. PMID 1147859.

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