Indications for intravenous and intraarterial digital subtraction angiography (DSA) in the diagnosis of cerebrovascular insufficiency. A new diagnostic concept including ultrasound.
For screening of arteriosclerotic lesions of the carotid bifurcation duplex scanning (B-mode imaging plus doppler flow analysis) is the method of first choice, because it is really noninvasive and offers the same results as intravenous DSA (IV DSA). IV DSA should not be performed as a screening procedure unless ultrasound examinations are not available or are inadequate. Except for patients with isolated unilateral stenosis of the internal carotid artery near the bifurcation confirmed with both duplex scanning and IV DSA, arteriography is required for therapy planning. Aortic arch angiogram, selective extra- and intracranial carotid arteriography and--if necessary--vertebral and subclavian arteriography can be performed with intraarterial DSA (IA DSA). The application of DSA to catheter arteriography will help to reduce further the potential risk of adverse reactions related to high intravasal contrast doses specially in the cerebral circulation, but will not turn arteriography into a risk-free procedure. Postoperative examinations of the carotid bifurcation can be performed with ultrasound as well as with IV DSA. Extracranial bypasses are best demonstrated with IV DSA. Extraintracranial bypasses can be demonstrated only with IA DSA.
D000792:Angiography / Q000379:methods*; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D011182:Postoperative Care; D011300:Preoperative Care; D013382:Subtraction Technique; D014463:Ultrasonography