Angiography of the internal carotid with use of the catheter technic.

Abstract

Since seldinger in 1953 introduced his technic of inserting a catheter percutaneously, this method, either in its original or modified form, has been widely used for the examination of various vascular areas. Cerebral angiography, however, is still performed mainly with direct injections of contrast material through the puncture needle, according to the procedure described by Lindgren (1947). The frequency of complications with this method has gradually decreased as technic has improved and better and less toxic contrast media have become available. There are still reports, however, of serious, sometimes lethal, complications. Inadvertent intramural contrast injection has been described by several writers, including Liverud (1958), who in one year had 3 deaths due to occluding dissecting aneurysms resulting from this accident. Saltzman (1959) reported 101 extravasal injections in a series of 1,020 cerebral angiographic studies. The number of clinical complications is not given. Replacement of the sharp puncture needle by a soft catheter should eliminate the risk of complications of this type. Another disadvantage of the needle technic is the rather low degree of selectivity. In Saltzman's series only 58.5 per cent were internal carotid angiographic studies, the other 41.5 per cent being classified as common carotid angiography. In addition, an unintentional injection into the external carotid was first made. That the catheter method has not been more commonly employed for cerebral angiography is no doubt due mainly to warnings against its use. Lindbom (1957) found a high frequency of spasm in the arteries of the extremity during catheter angiography. He assumes that anatomical resemblance between various vessels—in this case between the medium coarse muscular arteries of the extremities and the carotid artery—corresponds to a similarity in tendency to spasm and therefore warns against inserting a catheter into the carotid artery. Wickbom and Bartley (1957) arrived at a similar, although less categorical, conclusion after analyzing their arteriographic series on extremities. They mention 2 cases of complications among 20 carotid angiographic examinations with a catheter. At least one of these was believed to be due to arterial spasm. Clinical Material The catheter technic was employed in the performance of 124 internal carotid angiographic studies on 104 patients—45 females and 59 males—at Mölndal's Hospital (Mölndal, Sweden) between August 1956 and January 1959. The 124 examinations demonstrated 20 cerebral tumors (including cerebral metastases) and 15 vascular disorders consisting in arterial and arteriovenous aneurysms, carotid thromboses, and subdural hematomas. In 89 cases the findings were normal. Technic Premedication with morphine-scopolamine and a sterile technic are employed.