Digital Subtraction Neuroangiography: What a Resident Should Know

Abstract

Neuroangiography (NA) is an integral investigation in the management of patients with neurovascular diseases. NA is basically used for diagnosis, but in many instances, it may be followed up with treatment in the same sitting. Indications for diagnostic NA range from extracranial diseases (vertebra-basilar insufficiency from subclavian steal, extracranial carotid stenosis, cavernous-carotid fistula, neck trauma, epistaxis, etc.) to intracranial diseases (nontraumatic subarachnoid hemorrhage, cerebral aneurysms, cerebral arteriovenous malformations, cerebral vasospasm, acute stroke, etc.). A sound understanding of the principles of appropriate periprocedural care and anatomy, catheter technique, and basic disease pathology are vital for the test to be diagnostic. This pictorial review illustrates normal neurovascular anatomy along with an approach to analyze a spectrum of neurovascular pathologies and also explains a step-wise checklist for appropriate preprocedural assessment, technique of procedure, and postprocedural care of the patient. Basic knowledge on how to interpret these images and principles on how to perform it is important.

Cut-Out Towne-View Whole-Brain 320-Row Four-Dimensional Computed Tomography Angiography for Assessing the Anterior Intracranial Collateral Status: A Retrospective Study

“…When the original anteroposterior (AP)-view W4D-CTA images are transferred to picture archiving and communication systems (PACS) without any editing, W4D-CTA images can reach endovascular physicians quickly. However, in digital subtraction neuroangiography, Towne-view projections, defined as an AP view with a cephalocaudal angulation, are standard for visualizing anterior intracranial arteries [ 7 ]. Therefore, Towne-view W4D-CTA images may be more appropriate for the collateral status evaluation of anterior intracranial arteries before mechanical thrombectomy than the unedited AP-view images.…”

The role of combined computed tomographic angiography and digital subtraction angiography in the management of cervico-facial vascular lesions

“…The importance of DSA is to ensure the diagnosis of the vascular lesion in all patients and provide an accurate road map for them; also, treatment can be done in the same sitting [8,9]. Detailed full orientation of the carotid system vascular anatomy is essential for adequate embolization procedure.…”

“…Detailed full orientation of the carotid system vascular anatomy is essential for adequate embolization procedure. The external carotid artery (ECA) has multiple branches as the internal maxillary, facial, and superficial temporal arteries are the most important common branches which most of endovascular embolization procedures are done through [8].…”