Neuroradiology And Ultrasound

Fig. 2.8. a-c Internal carotid injection. a PA projection. bOblique projection, 30° in both planes. c Lateral projection.

Systemic complications are related to the contrast media or, very occasionally, to local anesthetics and sedation. Contrast media reactions are common to all radiological procedures using iodinated contrast. The risk is increased by history of previous reaction and in asthma sufferers, where the risk of severe reaction is about 0.2%.

Neurological complications range from headache to disabling stroke or death. The risks are increased in the older population (over 50 years), particularly if there is atherosclerosis, vasculitis or sickle cell disease. The patient

Fig. 2.8. a-c Internal carotid injection. a PA projection. bOblique projection, 30° in both planes. c Lateral projection.

needs to have consented to the procedure in the knowledge of these risks and a reasonable level of risk to quote is 1% for transient neurological deficit, permanent deficit 0.5% and death 0.1% [20].

Current Indications

Cerebral DSA remains the investigation of choice in a number of conditions despite improvements in Doppler ultrasound, MRA and CTA. The most common reason for its use is in the investigation of SAH, where DSA remains the gold standard. Even with good-quality angiography, in up to 20% of patients with SAH, no abnormality will be found and repeat angiography may be required. The peri-mesencephalic pattern of SAH is well recognized [21] in angio-graphically negative patients. The clinical course of these patients appears to be different from that of aneurysmal SAH. Such patients often appear "too well" to have had a SAH and clinical outcome is typically excellent. Even so, this pattern of hematoma is seen with CT in 10% of posterior fossa aneurysms. The PICA aneurysm can be missed if both distal vertebral arteries are not satisfactorily demonstrated by reflux or selective catheterization of both vertebral c a b

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