Basics of Angiography

Abstract

Cerebral angiography is an invaluable tool for the diagnosis and treatment of cerebrovascular disease. Due to its unparalleled spatial and temporal resolution, cerebral angiography still reigns as the gold standard for the evaluation of the cerebral vasculature. This chapter provides a brief introduction to cerebral angiography. It opens with a discussion of the indications for diagnostic angiography. It then covers pre-procedure patient evaluation, including history, labs, and imaging. The key elements of patient consent for angiographic procedures are reviewed. This chapter then takes the reader through some of the basic mechanics of performing a diagnostic angiogram in a step-by-step fashion. It begins with vessel access via transfemoral and transradial approaches, including the dorsal transradial approach. Catheter types and selection are briefly discussed. The basic anatomy and anatomic variants of the aortic arch are then reviewed. Techniques of catheter and wire manipulation, vessel selection, roadmapping, double flushing, and image acquisition are then covered. Finally, various methods and adjuncts for closure of the arteriotomy are described. This chapter concludes with a discussion of potential complications and their management.