Simplified selective femorocerebral angiography.

Abstract

In this country, as a rule, carotid angiography is performed by direct puncture and vertebral angiography by brachial catheterization or retrograde brachial injection. There are many, however, who sponsor other needle and catheter technics for cerebral angiography. Among these, advocates of the femoral catheter are scarce. With the catheters now available, selective femorocerebral angiography is a relatively difficult and time-consuming procedure for the average operator. The authors will describe a catheter which greatly simplifies this procedure. The femoral route is the best for selective cerebral angiography. It is the only one-puncture approach which gives access to all four major cerebral arteries for selective study. It provides maximum flexibility of operation for the angiographer (3). It is relatively easy to modify the approach to a diagnostic problem in mid-procedure if the findings on the early angiographs so dictate. At times it is the only adequate technic available for angiographic examination (6). The frequent use of general anesthesia during percutaneous carotid angiography indicates that, at best, it is a traumatic procedure. Almost all physical discomfort and emotional distress are eliminated by use of the femoral technic. With rare exception, general anesthesia may be omitted. Very little premedication is required. The procedure can be done on an out-patient basis. Other catheter methods do allow selective study of individual arteries, but, except for catheterization of the carotid per se, they do not permit individual study of the internal and external carotid arteries as does the femoral technic. In addition, the femoral approach will usually provide comparable or better vascular contrast. Catheter Description The original Ducor catheter2 designed by Viamonte and Stevens (7), is a polyurethane catheter within the wall of which is incorporated a wire braid. The braid enhances torsion control and strengthens the catheter (2). It is the torsion control in conjunction with preformed curves which makes this catheter useful in selective cerebral angiography. We use a modified 100 cm, 8F Ducor catheter with an inner diameter of 0.056 inches. The “pencil” tip has been somewhat blunted to minimize risk of intimal injury; the side-holes have been eliminated to reduce the chance of clotting in the catheter tip; and the distal 10 cm of the catheter have been constructed without braid to eliminate interference with catheter memory and to give flexibility in this segment (Fig. 1) (5). The catheter is given a “head-hunter” configuration by threading a shaping wire with the desired curves into the tip of the catheter and immersing it in boiling water for three minutes. After gas sterilization the catheter is ready for use. Figure 2 illustrates two basic head-hunting configurations, each with a modification demonstrated directly below.