Today, diagnostic methods in medicine have stepped far forward. This allows you to identify various diseases at an early stage, avoiding the development of serious consequences. One of these procedures is angiography of cerebral vessels. What is this technique, its indications, the features of the conduct will be discussed in detail below.
general characteristics
Angiography of cerebral vessels is a technique that relates to instrumental methods of research. During the procedure, the doctor can literally "see" the state of the vessels of the brain. This image can be obtained using x-rays.
This method has been known to mankind for over 100 years. Such a procedure was first performed by a neurologist from Portugal, whose name was E. Monitz, back in 1927. In clinical practice, this technique began to be applied after 9 years. In our country, angiography has been performed since 1954. It was started in Russia by neurosurgeons from Rostov, Nikolsky V. A., Temirov E. S. Today, this diagnostic method is still being improved. This allows you to assess the condition of the patient much more accurately than it was before.
How do angiography of cerebral vessels? This is a special diagnostic approach. Angiography is used to examine different vessels, not only in the brain. In this case, before the examination, the patient is injected with a special substance into the vessels. It stands out in contrast to X-rays. This allows you to assess the condition of the vessels, determine the place of their blockage, etc.
Angiography has both indications and contraindications. This is not a procedure that is suitable for all patients. However, it is quite informative, so it is assigned quite often. During the examination, the doctor can evaluate how the blood circulation in the brain passes, consider its phases and types (capillary, venous, arterial).
Features of the procedure
Many patients before the procedure are interested in how angiography of the vessels of the brain is performed. Therefore, before the procedure, you need to consider in detail the features of the examination.
The procedure involves vascular puncture. After the catheter is installed, a special substance is introduced into the body. It becomes clearly visible in x-rays.
It should be said that two main pools provide cerebral circulation. The first of these is called carotid. It forms the carotid artery. The second basin is called vertebrobasilar. This is the vertebral artery. Contrasting can be performed in one of the two pools presented. However, in the vast majority of cases, the substance is injected into the carotid artery.
Angiography with a contrast of cerebral vessels is performed using special drugs. They contain iodine. This, for example, can be cardiotrust, urographin, triiodotrust, etc. Drugs belong to the category of water-soluble. They are administered parenterally.
The difficulty in carrying out this procedure lies in the possibility of an allergy to iodine. Many patients have this feature of the body. Also, these drugs are nephrotoxic. They can affect kidney function. However, if very serious diseases are suspected, this examination is essential. It is prescribed if there is a suspicion of a tumor, a brain hematoma, circulatory disturbance due to a blood clot, aneurysm, or narrowing. Also, during the procedure, you can find the source of hemorrhage.
Varieties
Brain angiography can be of several types. Depending on the method of administration of the substance, it can be puncture or catheterization. In the first case, the substance is introduced into the vessel through a puncture needle. The second method involves bringing the needle to the vascular bed required for a specific examination.
Contrasting vessels may be different. There are general, selective and superselective angiography. They differ in the area of insertion of the catheter or puncture needle.
Visualization technique
The visualization technique may also vary. Previously, only the classical procedure was performed. To do this, a series of images was carried out using x-rays. Today, most often resort to angiography such as CT or MR. These are modern techniques that allow using computer equipment to present a picture of the state of the vessels of the brain.
CT angiography is performed using a tomograph. After that, the result goes through computer modulation. This allows you to look at the vessels in a 3D image.
Magnetic resonance angiography of cerebral vessels (MR angiography) is also called non-contrast. This allows you to get a reliable result without preliminary contrasting of the vascular bed. In some cases, special substances are still injected into the body in order to increase the information content of the examination.
Features of CT and MR techniques
Modern techniques are CT or MR angiography. In the first case, the procedure is carried out on a tomograph. Examination is carried out using x-rays. The radiation dose in this case is an order of magnitude less than with the classical approach. The computer processes the result and provides a three-dimensional image of the vessels.
In this case, the contrast agent is introduced into the vein at the elbow bend, which reduces the risk of complications. This procedure is possible for patients whose weight does not exceed 200 kg.
MR angiography allows for nuclear magnetic resonance imaging tests. It is much safer. The procedure can be carried out even during pregnancy. In this case, the contrast agent may not be used (if there is an allergy). This greatly expands the scope of the methodology. If there is no allergy, the substance is administered to increase the information content of the examination.
With severe claustrophobia and some mental illnesses, the method is not suitable. The patient should lie motionless long enough. In the presence of certain types of implants, some devices, as well as metal objects in the body, the procedure is also not performed.
Indications
Non-contrast angiography of cerebral vessels or other varieties have a number of contraindications and indications. Less traumatic for the body are CT and MR techniques. However, they also have a number of contraindications. Indications for this procedure may be a number of diseases or a suspicion of their development.
The procedure is prescribed for patients who have symptoms of the development of aneurysm (arterial or venous) of the brain. Also, this examination is necessary if there is a suspicion of the appearance of arteriovenous malformation.
The procedure allows you to determine the degree of narrowing (stenosis) or blockage (occlusion) of blood vessels. In this case, you can establish whether there is a gap in them. The procedure allows you to assess the degree of atherosclerotic type changes in the vessels of the brain, and also decide on the need for surgical intervention.
Considering what the angiography of cerebral vessels shows, it can be noted that the procedure will also be informative in establishing the relationship of arteries, veins and capillaries, which are located next to the tumor. This is necessary for planning access during the operation to the neoplasm. You can also control the location of the clips that are placed on the vessels.
Complaints of tinnitus, headache, or dizziness are not indications for angiography. Patients in this case should consult a neurologist. Only after other examinations that reveal a number of characteristic symptoms, a vascular examination is prescribed. Do not go through a similar procedure yourself. It should be prescribed by a doctor if necessary.
Doctors reviews
Considering the reviews about angiography of cerebral vessels that doctors leave, it is worth noting the high informational content of the procedure. However, doctors say that such an examination is prescribed as a last resort. The fact is that even modern examination methods have a number of contraindications.
A contrast procedure is not performed for patients who are allergic to iodine or other radiopaque drugs. It is also strictly forbidden to perform such an examination during pregnancy. This statement is true for classical and CT angiography. In this case, it is permissible to perform only angiography of the cerebral vessels without contrast. In this case, the patient should not have specific contraindications.
In the presence of certain mental illnesses, the procedure is also not performed. There are pathologies of this type in which a person cannot help but move in the process. Also a contraindication is the presence of an infectious disease or inflammatory process in the acute stage. In this case, the risk of complications increases significantly.
Before the examination, a coagulogram of the patient is provided. In the presence of abnormalities in blood coagulability (both up and down), the procedure is prohibited. If the patient's condition is assessed as severe, the procedure is also not performed. In other cases, if there are appropriate symptoms, the examination is prescribed as one of the most informative.
Where to get tested?
Many patients ask where to do angiography of cerebral vessels. Today in almost every regional medical institution. The procedure may be free or paid. In the first case, you can go through an examination, which will pay for medical insurance. The quality and conditions of such a procedure depend on the type of contract concluded by the patient. To do this, you need to get a referral from the appropriate doctor.
You can also get a quota examination for free. In this case, you will need to queue and undergo the procedure on the appointed day. Most often it will be a classic angiography technique. Since sometimes it takes a long time to wait, which in many cases is unacceptable, and also because of the features of the classical diagnostic method (high radiation exposure), many patients prefer to undergo angiography using the CT or MR method in paid clinics.
Modern equipment is in many clinics in Moscow and regional centers, large cities of Russia. How much does cerebral angiography cost? In the capital, a similar examination can be done at a price of 5 to 12 thousand rubles. The cost depends on the chosen survey methodology, as well as the range of services that are included in the price. In some cases, the price indicates that angiography costs 5 thousand rubles. However, the introduction of a catheter or puncture needle, as well as drugs, must be paid separately.
Positive feedback from patients is received by metropolitan clinics, for example, SM-Clinic, Best Clinics, MedicCity, etc. The most modern equipment is used here. This significantly reduces the risk of complications. At the same time, the quality of such diagnostics will be an order of magnitude higher than when using the classical approach or outdated equipment. The quality of such a procedure is not inferior to the European level. At the same time, the cost of examination in domestic clinics will be an order of magnitude lower.
Preparation
Before the procedure, you will need to undergo some preparation for angiography of the vessels of the brain. This allows you to get an accurate examination result. With proper preparation, the risk of complications will be minimal.
Before prescribing angiography, the doctor will give the patient a referral for a general, as well as a biochemical blood test. The coagulation index is also determined. Moreover, such examinations are carried out no earlier than 5 days before angiography. It will be required to provide data on the blood group, as well as its Rh factor. This is necessary if complications arise during or after the procedure.
You will also need to do an ECG and fluorography (the result that was obtained no later than 12 months ago is suitable).
Before the test, it is strictly forbidden to take any alcohol for 2 weeks. Also, a week before the examination, it is necessary to exclude the use of drugs that affect blood coagulation.
The day before the procedure, the patient is injected with a sample of a contrast agent intravenously. It is very small (only 0.1 ml). If itching, shortness of breath and other allergic manifestations appear, the procedure is not performed.
Immediately before the procedure (the day before), antihistamines are taken. Sometimes it is also required to take tranquilizers, but only as directed by a doctor. 8 hours before the examination, stop eating, and 4 hours before angiography do not drink water. Before sending to a medical institution you need to swim and shave the place of puncture or catheterization. All metal objects must be removed before the survey.
Some nuances
There are several nuances of how angiography of the vessels of the brain is performed. Before the procedure, the patient will need to sign a consent to conduct this examination. A catheter is then administered intravenously. CT and MR techniques suggest its introduction into the vein on the elbow bend. In 20-30 minutes Before the procedure, a number of drugs are administered. These are painkillers, antihistamines and tranquilizers. This significantly reduces discomfort.
After that, the patient takes a horizontal position. He is constantly measured using special equipment for pulse and pressure. Next, the skin is treated with an anesthetic and a puncture of the carotid or vertebral artery. Getting into them is pretty hard. Therefore, the femoral artery is punctured more often. The catheter is carried out to the place of study. This is a painless procedure, since the vessels inside do not have nerve endings.
Next, a contrasting drug is introduced, heated to body temperature (volume 8-10 ml). During this, a metallic taste may appear in the mouth. Blood rushes to the face, sweating increases. This is normal. This will pass in a few minutes. Take pictures. The doctor immediately evaluates them. If additional diagnostics are needed, another portion of the substance is administered and the procedure is repeated from the desired angle. Then the catheter is removed, a bandage is applied. The patient is monitored for 6-10 hours. Then you can go home.
Having examined the features of cerebral angiography, we can get an idea of this procedure.