Cerebral angiography with miokon.

Abstract

Cerebral angiography has come to be one of the most valuable diagnostic procedures in the neurosurgical armamentarium. By injecting a contrast medium into the large vessels supplying circulation to the brain, one can detect and diagnose conditions which were previously impossible to demonstrate. In the development of cerebral angiography, however, many problems have arisen from the irritative effect of the contrast material on the arterial tree and perhaps even on the cerebral substance itself, producing a rather disturbing group of reactions ranging from a mild flushing and tingling sensation to shock and, in some instances, death. In spite of these hazards, as information accumulated it was realized that the procedure was vital, first to the progress of neurosurgery and, more recently, of vascular surgery. The media originally used for angiography were, as in most beginnings, somewhat crude. It was even necessary, some believed, that anesthesia be utilized to allay the patient's suffering during the examination. This, it was thought, had a tendency to soften the blow and cushion the tendency to reaction. Continued search for less toxic drugs has been going on since the introduction of the procedure, so that it may be accomplished with less disturbance to the patient and without the use of additional noxious agents for their anesthetic effect. We believe that in the product Miokon Sodium 30 per cent this problem has come much nearer to solution. Miokon Sodium has been used for intravenous urography in as high a concentration as 50 per cent. For cerebral angiography, however, it is recognized that the lowest concentration which will afford diagnostic films should be employed. Clinical trials with Miokon Sodium 30 per cent, which had been found in pharmacological tests to have an extremely low toxicity, have convinced us that it is by far the best of the drugs utilized thus far for this purpose. Miokon Sodium is a brand of sodium diprotrizoate, the sodium salt of 3,5-bispropionamido-2,4,6-triiodobenzoic acid, an organic salt containing 57.3 per cent of iodine. It has proved to be among the least toxic of the materials in general use as contrast media for urography. In preliminary tests with massive doses, it was found that injection of fifteen to twenty times the maximum amounts recommended for man was tolerated by rats, mice, and dogs without evidence of serious toxicity. With the trypan blue staining technic no blood-brain barrier damage could be demonstrated in normal dogs, and no changes were seen in the electroencephalogram following the carotid injection of a total of 25 ml. of the medium in four seconds. As in the case of the injection of any iodine substance, the usual precautions must be kept in mind. These are well known.