Brachial angiography for the evaluation of carotid artery occlusion in the treatment of "posterior communicating" aneurysm.

Abstract

COMMON CAROTID artery occlusion is a useful surgical procedure for the treatment of intracranial carotid artery aneurysms which arise near the origin of the posterior communicating or posterior cerebral arteries (5, 9, 11). This therapy yields patient-survival results comparable to those achieved by intracranial surgery (11). Postoperative cerebral angiography has become a routine part of the overall evaluation of the aneurysm patient. The examination is of greatest importance when the patient has been treated by carotid artery ligation. Angiography is the only way to assess changes in aneurysm size. Most treated aneurysms decrease in size; rarely, however, aneurysms have been reported to enlarge following ligation, and small, previously unnoticed aneurysms may present as a new finding (3, 4). Cerebral ischemia is the principal danger of common carotid artery occlusion (10). Thus, an evaluation of cerebral circulation and collateral blood supply may yield significant patient and research information. The purpose of this paper is to describe what we believe to be the advantages of percutaneous retrograde brachial angiography in the postoperative evaluation of patients with intracranial aneurysms who have been treated by common carotid artery ligation. Material and Methods Retrograde brachial angiography performed on the same side as the carotid ligation has been the primary angiographic investigation for postoperative evaluation at the authors' institution for the past three and a half years (5). Contralateral brachial or carotid angiography was performed only when necessary. Percutaneous puncture of the brachial artery is accomplished in the midarm with a No. 16, thin-walled, modified Cournand needle. Forty cubic centimeters of 60 per cent methylglucamine iothalamate is injected with a Taveras injector set at 626 lb. per sq. in. pressure. Simultaneous biplane serial films are taken to include both the neck and the head (1). The preoperative and postoperative angiograms of 19 patients who underwent common carotid ligation were reviewed. All had aneurysm of the internal carotid artery near the origin of the posterior communicating artery. Results Seven aneurysms were on the left internal carotid artery, and 12 were on the right. Ipsilateral brachial angiography adequately visualized both the parent vessel and the aneurysm in 15 of the 19 patients. The vertebral artery (one right, one left) was hypoplastic in 2 of the unsuccessful brachial examinations. In one of these, contralateral brachial angiography produced excellent visualization of the parent vessel and aneurysm. In the other, at contralateral carotid angiography, the parent artery failed to fill despite bilateral anterior cerebral artery filling. Contralateral brachial angiography was not performed. The third unsuccessful brachial angiographic examination resulted from untoward technical factors.