Efficacy and safety of digital subtraction angiography with special reference to contrast agents

Abstract

We evaluated the diagnostic accuracy and complications of digital subtraction angiography (DSA) in a series of clinical trials conducted on patients primarily with cerebral vascular disease and those evaluated before and after surgery or percutaneous transluminal angioplasty. Double-blind studies of the carotid-vertebral arteries of 300 of the 2,200 patients using DSA imaging and a variety of ionic and nonionic contrast agents showed that although subjects tolerated the injection of nonionic contrast better than ionic, nonionic contrast administration did not lead to better image quality. Of 764 patients receiving ionic contrast media, 3.3% had mild-to-serve adverse reactions; of 350 injected with nonionic contrast agents, 1.7% had mild-to-severe adverse reactions. If the sole consideration is safety, use of ionic contrast media is justified.

Digital subtraction angiography (DSA) in neuroradiology

“…The tip can be placed either through an arm vein into the cephalic or basilic vein [2,14,25,29] or into the right atrium [19]. Another method consists of puncturing the femoral vein, which we also selected in our patients, with the catheter placed in the right atrium or in the superior vena cava or the subclavian vein [44]. When the brachial vein is punctured, the contrast flow for evaluation of the extracranial vessels is 10 to 15 ml/second, with 0.4 to 1.0 ml contrast medium administered per kilogram body weight [3,21,29].…”

“…Apart from possible allergic episodes, thrombosis or thrombophlebitis of the veins are complications likely to arise after i.v. injection of contrast or after puncture of the cubital artery [21,39,44].…”

“…By the use of a 256x256 matrix, Chilcote et al 1981 [9] managed to achieve positive results in the evaluation of the carotid bifurcation in 71% of cases. When using a 512x512 matrix, the positive score amounted to roughly 80% [1,6,14,22,43,44]. The aortic arch and the two subclavian arteries can be readily assessed (Figs.…”

“…In the meantime, this method has been applied in the entire range of arteriography [3,13,15,21,28,41,42,46]. For the appraisal of cervical and intracranial lesions, the arterial administration of contrast medium is increasingly gaining ground over intravenous injection [2,18,35,39,44]. With a survey of literature to hand and in the light of personal experience, an attempt will be made to review the possibilities afforded by DSA in the assessment of neurological and neurosurgical clinical pictures.…”

“…The equipment required for this is made up of a high-efficiency X-ray generator, a high resolution image intensifier, a video camera, an electronic computer and a digital memory of high capacity and rapid data acquisition. Under optimal conditions, 2000 different attenuation values can be differentiated by video cameras [12,16,29,36,44]. From the digital modulation, the subtraction image is converted back into analogue representation, so that it can be seen on the TV monitor instantly without any delay [21].…”