IMPROVED PUNCTURE TECHNIQUE FOR CEREBRAL ANGIOGRAPHY: PRELIMINARY REPORT.

Abstract

In most vascular examinations the needle has been replaced by a smooth plastic catheter in order to permit movement of the patient for different projections without the risk of vessel wall damage by the sharp end of the needle. In cerebral angiography the conventional needle method is still used by most neuroradiologists despite many reports on serious complications due to subintimal or extravascular contrast injections and despite the comparatively good results in carotid catheterisation with the Seldinger technique reported especially from Norway. The reason for the persistence of the needle puncture technique is probably that the decreased rate of complications with the catheter method is felt to be unimportant in comparison to its relatively complicated and time-consuming technical requirements. Percutaneous cerebral angiography was originally described by Loman and Myerson (1936). Lindgren (1947) gave important aspects of the technique which are still valid and have, in the main, gained general acceptance. He recommended examination under local anaesthesia and puncture of the internal carotid artery in order to obtain cerebral angiograms of high quality with minimal amounts of contrast medium. He also recommended the use of a short bevel needle having an internal diameter of about 1 mm and connected to a flexible tubing filled with saline during the puncture. Despite the policy of selective injection into the internal carotid artery Lindgren reported 40 out of 153 examinations to have been performed via the common carotid artery.