Non-invasive imaging of the vertebral artery

Abstract

Direct visualization of the vertebral arteries has first become possible with the introduction of angiography in the 1960s. The vertebrobasilar system could be visualized by retrograde injection of iodine contrast medium within the humeral arteries. Direct puncture of the vertebral artery was also routinely performed at the time I started my neuroradiological training in the late 1960s. A special needle with a lateral hole allowed direct puncture of the artery, usually on the left side, introduced at the mid-cervical level. This technique unfortunately was quiet aggressive, ‘blind’ and often, perivascular injections were deplored. Later on, Seldinger described the catheterization techniques using the femoral or humeral approach allowing selective catheterization of the different arterial trunks feeding the vascularization of the brain (1). Still, those techniques are invasive due to the introduction of a large trocar allowing the introduction of a round-tipped guide wire and finally a catheter. Iodine contrast medium and X-rays were moreover used to perform the procedure.