An Improved Technic for Percutaneous Cerebral Angiography

Abstract

CEREBRAL angiography can be performed by open surgical procedure, with direct injection of the common carotid artery, or by percutaneous needle puncture of the carotid artery. The open technic is time consuming, is a surgical procedure and leaves an unsightly scar. The percutaneous method also has disadvantages, such as the possibility of the injection of opaque medium into the perivascular tissues and the danger of manipulating the head while the needle is in the artery.One of us (D. C. D.) thought these disadvantages of the percutaneous technic could be overcome and devised the following modification: With the patient on a fluoroscopic table, and after the usual preparation for a minor surgical procedure, the common carotid artery is palpated, and the point of maximum pulsation is found. With the use of local anesthesia, percutaneous puncture of the artery is performed. We have been using a 3 inch, 17 gage Huber point needle of special design ( fig. 1). The hub plate permits greater control of the needle, and the Huber point is less traumatic than an open bevel point. The stylet is used to facili¬ tate skin puncture but is removed before arterial puncture. After a successful arterial puncture, a small radiopaque catheter is threaded through the needle and up the internal carotid artery. (This method did not originate with us, since Radner 1 had previously reported vertebral artery angiography, using the catheter method.) Under fluoroscopic control, the catheter is passed until its tip is well into the artery. The needle is then withdrawn. Continuous, slow injection of sterile isotonic sodium chloride solution through the catheter is employed to prevent blockage.From the

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“…Postangiographic compression for hemostasis was obviously not possible. The initial approaches to percutaneous arterial catheterization were developed in the late 1940s and early 1950s by Donald et al [2], Peirce [3], and Lindgren [4] and involved passing a catheter through a large bore needle placed percutaneously. Seldinger [5], noting the danger in using such a large sharp needle both to the artery in which it was placed as well as to the catheter, dramatically improved the technique by introducing his needle/guidewire/catheter exchange method in 1953.…”

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