Brachiocephalic angiography in atheromatous disease.

Abstract

For several years visualization of the origins of vessels supplying the brain has been feasible. Successful correction of a neurologic deficit attributed to reduced blood flow depends upon precise information concerning the site and extent of disease (1, 2), Brachiocephalic angiography may pinpoint the lesion, and this paper will describe the technic and results of such a procedure. Premedication of the fasting patient includes administration of Benadryl, atropine, and Seconal. In the beginning an open method for catheter insertion was employed, but for the past year we have used the Seldinger technic. Under fluoroscopic control the catheter is positioned in the innominate artery proximal to the origin of the common carotid, and in the subclavian artery near the origin of the left vertebral artery. In addition to the frontal view centered on the lower edge of the thyroid cartilage, the shoulder girdles are placed in alternate oblique positions with the head turned to the lateral position. Thus, three injections are ordinarily made through alternate catheters. Originally we used 15 c.c. of 50 per cent Hypaque. Gradually the volume was increased, and the concentration decreased so that we now use 40 c.c. of 25 per cent Hypaque except for the anteroposterior view for which we sometimes use 40 c.c. of 50 per cent Hypaque. Occasionally we have used 60 c.c. of 25 per cent Hypaque, when there has been extreme interest in displaying the entire intracranial system. The contrast material was injected with an Amplatz injector using 70 to 80 lb./sq. in. We investigate the cerebral circulation by percutaneous carotid injection in approximately 300 patients annually. About 60 of these have now been studied with the Seldinger technic, and the findings of this report are limited to the first 53. Indications for brachiocephalic angiography include one or more of the following transient symptoms : vertigo or dizziness, diplopia, dysarthria or other speech difficulty, perioral numbness, hemiparesis, hemi-anesthetic sensations, or alteration of consciousness. Observed complications have been limited to convulsions (2 cases), blindness (2 cases), shoulder petechiae (4 cases), broken guide wire (1 case), and worsening of hemiplegia (1 case). The blindness was transient, and the hemiplegie patient had a thalamic glioma which could easily explain the progressive deterioration. The broken guide wire was avoidable. No good explanation has been offered for the petechiae. Following the injection of the right brachial catheter satisfactory visualization was thought to occur as follows: right vertebral artery 49/53 cases, basilar artery 42/53, extracranial right carotid artery 44/53, intracranial right carotid artery 2/53, and left common carotid artery 7/53. After the injection of the left brachial catheter it was thought that visualization was satisfactory in the left vertebral artery (38/40 cases) and intracranial basilar artery (33/40).