Diagnostic Cerebral Angiography: Archaic and Complication-Prone or Here to Stay for Another 80 Years?

Abstract

1435 made no reference to patient consent, and preclinical evaluation of the toxicity of the strontium bromide contrast material initially used was less than thorough [3]. This was the infancy of cerebral angiog­ raphy, when carotid arteries were surgically exposed for injection. In 1931, Moniz began using Thorotrast (colloidal thorium dioxide, a contrast agent no longer used), with its perpetual α­particle emission (biologic half­ life of 500 years) and resultant induced malignancies [3, 4]. In 1936, per cutaneous carotid angiography was introduced [5]. It was 1953 when Seldinger [6] made the monumental introduction of the technique of percutaneous transfemoral catheterization, and the development of pre shaped catheters for selecting brachio cephalic vessels soon followed [7, 8]. In the days before cross­sectional imaging, when skull radiography and pneumo­ encephalography were the only nonangio­ graphic means of imaging the head, cerebral angiography was a wonderful option. Of course, vascular lesions such as aneurysms and AVMs were well evaluated, but angiog­ raphy also could represent the only chance of evaluating CNS tumors—remember the square and round shifts? There was just that persistent, unavoidable problem that patients could suffer infarcts, or even death, from cerebral angiography. In two of the 100 most­cited AJR articles from its first century of publication, Mani et al. [9] and Earnest et al. [10], respectively, reported on the complication rates of cerebral angiog­ raphy on 5,000 angiograms retro spectively Diagnostic Cerebral Angiography: Archaic and Complication-Prone or Here to Stay for Another 80 Years?