Cerebral angiography

Cerebral angiography
Intervention
Cerebral angiogram showing a transverse projection of the vertebrobasilar and posterior cerebral circulation.
ICD-9-CM	88.41
MeSH	D002533
MedlinePlus	003799
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Cerebral angiography is a form of angiography which provides images of blood vessels in and around the brain, thereby allowing detection of abnormalities such as arteriovenous malformations and aneurysms. It was pioneered in 1927 by the Portuguese neurologist Egas Moniz at the University of Lisbon, who also helped develop thorotrast for use in the procedure.

Typically a catheter is inserted into a large artery (such as the femoral artery) and threaded through the circulatory system to the carotid artery, where a contrast agent is injected. A series of radiographs are taken as the contrast agent spreads through the brain's arterial system, then a second series as it reaches the venous system.

For some applications this method may yield better images than less invasive methods such as computed tomography angiography and magnetic resonance angiography. In addition, cerebral angiography allows certain treatments to be performed immediately, based on its findings. If, for example, the images reveal an aneurysm, metal coils may be introduced through the catheter already in place and maneuvered to the site of aneurysm; over time these coils encourage formation of connective tissue at the site, strengthening the vessel walls.

In some jurisdictions, cerebral angiography is required to confirm brain death.

Prior to the advent of modern neuoroimaging techniques such as MRI and CT in the mid-1970s, cerebral angiographies were frequently employed as a tool to infer the existence and location of certain kinds of lesions and hematomas by looking for secondary vascular displacement caused by the mass effect related to these medical conditions. This use of angiography as an indirect assessment tool is nowadays obsolete as modern non-invasive diagnostic methods are available to image many kinds of primary intracranial abnormalities directly.