What are symptoms of vascular risk?
Sudden and severe headache
Vision disturbance
Dizziness or vertigo
Weakness of one part of the body
Numbness/tingling of face or scalp
Swallowing problems
Slurred speech
Fainting
Confusion
Pulsatile tinnitus
What is digital subtraction angiography?
A medical imaging technique that uses X-rays and a computer to create clear pictures of blood vessels by digitally “subtracting” background structures like bone, highlighting only the contrast dye-filled vessels for diagnosing vascular issues
When issues with blood flow are identified during an angiogram, treatment can take place during the procedure
What is a cerebral angiography?
Invasive procedure
Doctor feeds a catheter into a blood vessel near the groin or in the arm
Guides it through the circulatory system to an artery feeding the brain (to the carotid, vertebral, or subclavian artery) - using fluoroscopy to guide
Dye is introduced via the arteries for vessel opacification
An iodine-based contrast agent is injected to provide visualization of the vessels (iodine makes the vessels opaque to x-rays)
As we learned when studying CT scans, iodine attenuates x-rays and in the case of angiography creates the outline of the vessels carrying the contrast dye
Image display for an angiogram is different than CT
Where CT assigns attenuation values, angiography uses digital subtraction
The image before the contrast dye is injected is compared to the image after contrast material is added, removing all stationary background structures to focus on enhanced blood vessels
The final processed image is inverted, presenting as dark, but the iodine itself results in a high x-ray attenuation value similar to CT scans
Since vascular disorders of the brain can significantly impact the auditory and vestibular system, we will concentrate on cerebral angiography in this course
Are AVMs usually found incidentally?
Yes, most people don’t know that they have them
Can fluoroscopy and angiography can be performed by any number of trained physicians?
Yes, including interventional cardiologists, interventional radiologists, and vascular surgeons
Can cerebral angiography be used to visualize blood flow to look for abnormalities that may lead to stroke?
Yes, such as…
Aneurysm, enlargement of an artery (bulge or ballooning)
Tumor
Blood clots
Arterial stenosis, narrowing of a blood vessel
Blood clot, blockage of a blood vessel
Arteriovenous malformation (AVM), abnormal tangle of vessels
What are the benefits of cerebral angiogram?
Detailed picture of blood vessels in the brain
Combine diagnosis and treatment into a single procedure
X-ray exposure is low
Typically no side effects of the exam
What are the potentially harmful effects of a cerebral angiogram?
Allergic reaction to contrast dye
Radiation exposure
Risk of stroke
Tissue damage around IV site
Age related risk
Kidney damage
What is fluoroscopy?
Fluoroscopy is a tool used in diagnostic angiography to create a real-time x-ray video to assess arteries and veins, allowing doctors to diagnose and treat conditions related to how blood moves through vessels
A continuousx-ray beam is passed through the body part being examined
Fluoroscopy, as an imaging tool, enables physicians to look at many body systems, including the skeletal, digestive, urinary, respiratory, and reproductive systems
What is CT- Angiography?
Combines CT and angiography
Less invasive than traditional angiography
Contrast dye: iodine-based
Preferred for patients with metal
Good for diagnosis of aneurysm, vertebrobasilar disease, atherosclerosis, and vascular malformations
Quick and reliable
What is MR- Angiography?
Combines MR and angiography
Less invasive than traditional angiography and CTA
Contrast dye: gadolinium-based
Preferred for patients with kidney issues and reduced exposure to radiation
Good for diagnosis of aneurysm, vertebrobasilar disease, atherosclerosis, vascular malformations, and stroke
Does not assess direction of blood flow like DSA
What is a cerebral aneurysm?
Bulge or weak area of an artery
Asymptomatic
Up to 6% of the US population are unaware
Rupture can be life-threatening
Delaying treatment increases the likelihood of disability or death
Risk factors: age, female, High Blood Pressure, cigarettes, and trauma
What is an endovascular embolization?
A minimally-invasive treatment where a catheter is inserted into a major artery in the wrist or groin and threaded through the blood vessels to the site of the brain aneurysm
A guide wire is used to insert the catheter into the carotid artery
Coils are passed through the catheter and then released into the aneurysm, filling the aneurysm and preventing blood from flowing into the weakened area isolating the aneurysm, preventing blood flow to the area
This decreases the chances of rupture and reduces the risk of stroke from embolus or blood clots
When the opening of the aneurysm it too wide, it can be treated by placing a special stent called a flow diverting stent across the base of an aneurysm
This leads to clotting and shrinkage of the aneurysm, eventually blocking it off from the main artery
