Today, diagnostic methods in medicine have stepped far forward. This allows you to identify various diseases at an early stage, preventing the development of serious consequences. One of these procedures is angiography of the vessels of the brain. What this technique is, its indications, the features of the implementation will be discussed in detail below.
General characteristics
Cerebral angiography is a technique that belongs to instrumental research methods. During the procedure, the doctor can literally "see" the state of the vessels of the brain. You can get such an image using x-rays.
This method has been known to mankind for over 100 years. For the first time, such a procedure was carried out by a neurologist from Portugal, whose name was E. Moniz, back in 1927. In clinical practice, this technique began to be usedafter 9 years. Angiography has been carried out in our country since 1954. It was started in Russia by neurosurgeons from Rostov Nikolsky V. A., Temirov E. S. Today, this diagnostic method is still being improved. This allows you to assess the patient's condition much more accurately than before.
How is cerebral angiography performed? This is a special diagnostic approach. Angiography is used to examine various vessels, not only in the brain. In this case, before the examination, the patient is injected into the vessels with a special substance. It stands out in contrast in the light of x-rays. This allows you to assess the condition of the vessels, determine the places of their blockage, etc.
Angiography has both indications and contraindications. This is not a procedure that suits all patients. However, it is quite informative, so it is assigned quite often. During the examination, the doctor can assess how the blood circulation in the brain proceeds, consider its phases and types (capillary, venous, arterial).
Features of the procedure
Many patients before the procedure are interested in how the angiography of cerebral vessels is performed. Therefore, before the procedure, you need to consider in detail the features of the examination.
The procedure involves vascular puncture. After the catheter is installed, a special substance is introduced into the body. It becomes clearly visible in x-rays.
It should be said that two main pools provide cerebral circulation. The firstof which is called carotid. It is formed by the carotid artery. The second pool is called vertebrobasilar. This is the vertebral artery. Contrasting can be performed in one of the two presented pools. However, in the vast majority of cases, the substance is injected into the carotid artery.
Angiography with contrast of cerebral vessels is performed using special preparations. They contain iodine. This, for example, can be cardiotrast, urografin, triiodtrast, etc. The drugs are classified as water-soluble. They are administered parenterally.
The difficulty in carrying out this procedure lies in the possibility of an allergy to iodine. Many patients have this feature of the body. Also, these drugs are nephrotoxic. They can affect kidney function. However, if very serious diseases are suspected, this examination is essential. It is prescribed for suspected tumors, cerebral hematomas, circulatory disorders due to a blood clot, aneurysm, or narrowing. Also during the procedure, you can find the source of the hemorrhage.
Varieties
Angiography of cerebral vessels can be of several types. Depending on the method of administration of the substance, it can be puncture or catheterization. In the first case, the substance is injected into the vessel through a puncture needle. The second method involves bringing the needle to the vascular bed required for a particular examination.
Contrasting of vessels can be different. There is a general, selective and superselective angiography. They differthe area where the catheter or puncture needle is inserted.
Visualization technique
The visualization technique may also differ. Previously, only the classical procedure was performed. For this, a series of X-ray images were taken. Today, most often resort to angiography such as CT or MR. These are modern techniques that allow using computer equipment to present a picture of the state of the vessels of the brain.
CT angiography is performed using a tomograph. The result is then computer modulated. This allows you to look at the vessels in 3D.
Magnetic resonance angiography of cerebral vessels (MR angiography) is also called non-contrast. This allows you to get a reliable result without preliminary contrasting of the vascular bed. In some cases, special substances are still injected into the body in order to increase the information content of the examination.
Features of CT and MR techniques
Modern techniques are CT or MR angiography. In the first case, the procedure is carried out on a tomograph. The examination is carried out using x-rays. The radiation dose in this case is an order of magnitude less than in the classical approach. The computer processes the result and provides a three-dimensional image of the vessels.
In this case, a contrast agent is injected into a vein at the bend of the elbow, which reduces the risk of complications. This procedure is available for patients weighing less than 200 kg.
MR-angiography allows you to conduct an examination using the method of nuclear magnetic resonance. It's much safer. The procedure can be carried out even during pregnancy. In this case, the contrast agent may not be used (if there is an allergy). This greatly expands the scope of the technique. If there is no allergy, the substance is administered to increase the information content of the examination.
The method is not suitable for severe claustrophobia and some mental illnesses. The patient should lie still for a long time. In the presence of certain types of implants, some devices, as well as metal objects in the body, the procedure is also not carried out.
Indications
Non-contrast angiography of cerebral vessels or other varieties have a number of contraindications and indications. CT and MR techniques are less traumatic for the body. However, they also have a number of contraindications. The indications for this procedure may be a number of diseases or suspicion of their development.
The procedure is prescribed for patients who have symptoms of the development of an aneurysm (arterial or venous) of the brain. Also, this examination is necessary if there is a suspicion of the appearance of an arteriovenous malformation.
The procedure allows you to determine the degree of narrowing (stenosis) or blockage (occlusion) of blood vessels. In this case, you can determine whether there is a gap in them. The procedure allows assessing the degree of changes in the atherosclerotic type in the vessels of the brain, as well as making a decision on the need for surgicalintervention.
Considering what angiography of cerebral vessels shows, it can be noted that the procedure will also be informative in establishing the relationship of arteries, veins and capillaries that are located next to the tumor. This is necessary for planning access during the operation to the neoplasm. You can also control the location of the clips that are applied to the vessels.
Complaints of tinnitus, headache or dizziness are not indications for angiography. Patients in this case should consult a neurologist. Only after conducting other examinations that reveal a number of characteristic symptoms, an examination of the vessels is prescribed. It is not necessary to go through such a procedure on your own. It should be prescribed by a doctor if necessary.
Reviews of doctors
Considering the reviews about angiography of cerebral vessels left by doctors, it is worth noting the high information content of the procedure. However, doctors say that such an examination is prescribed as a last resort. The fact is that even modern examination methods have a number of contraindications.
Contrast procedure is not performed on patients who are allergic to iodine or other radiopaque agents. It is also strictly forbidden to perform such an examination during pregnancy. This statement is true for classical and CT angiography. In this case, it is permissible to perform only angiography of cerebral vessels without contrast. In this case, the patient should not have specific contraindications.
In the presence of certain mental illnesses, the procedure is also not performed. There are pathologies of this type, in which a person cannot help but move during the procedure. Also a contraindication is the presence of an infectious disease or an inflammatory process in the acute stage. In this case, the risk of complications increases significantly.
Before the examination, the patient's coagulogram is provided. In the presence of deviations in blood clotting (both up and down), the procedure is prohibited. If the patient's condition is assessed as severe, the procedure is also not performed. In other cases, if there are appropriate symptoms, the examination is assigned as one of the most informative.
Where to get tested?
Many patients ask where to do angiography of cerebral vessels. Today, in almost every regional medical institution. The procedure can be free or paid. In the first case, you can undergo an examination, which will pay for medical insurance. The quality and conditions of such a procedure depend on the type of contract entered into by the patient. To do this, you need to get a referral from the appropriate doctor.
You can also get a quota examination for free. In this case, you will need to stand in line and undergo the procedure on the appointed day. Most often, this will be the classical technique of angiography. Since sometimes it takes a long time to wait, which in many cases is unacceptable, and also due to the peculiarities of the classical diagnostic method (high radiation exposure), many patients preferundergo angiography using the CT or MR method in paid clinics.
Modern equipment is available in many clinics in Moscow and regional centers, large cities of Russia. How much does a cerebral angiography cost? In the capital, you can undergo such an examination at a price of 5 to 12 thousand rubles. The cost depends on the chosen method of examination, as well as the range of services that are included in the price. In some cases, the price indicates that angiography costs 5,000 rubles. However, the introduction of a catheter or puncture needle, as well as drugs, have to be paid separately.
Positive feedback from patients is received by capital clinics, for example, "SM-Clinic", "Best Clinic", "MedicCity", etc. The most modern equipment is used here. This greatly reduces the risk of complications. At the same time, the quality of such diagnostics will be an order of magnitude higher than when using the classical approach or outdated equipment. The quality of such a procedure is not inferior to the European level. At the same time, the cost of examinations in domestic clinics will be an order of magnitude lower.
Preparation
Before the procedure, you will need to undergo some preparation for an angiography of cerebral vessels. This allows you to get an accurate test result. With proper preparation, the risk of complications will be minimal.
Before prescribing angiography, the doctor will give the patient a referral for a general, as well as a biochemical blood test. The blood clotting index is also determined. At the same time, such examinations are carried out no earlier than 5 days before angiography. Would needprovide data on the blood type, as well as its Rh factor. This is necessary if complications arise during or after the procedure.
You will also need to do an ECG and fluorography (a result that was received no later than 12 months ago will do).
Before the examination, it is strictly forbidden to take any alcohol for 2 weeks. Also, a week before the examination, it is necessary to exclude the use of drugs that affect blood clotting.
The day before the procedure, the patient is given a sample of contrast agent intravenously. It is quite small (only 0.1 ml). If itching, shortness of breath and other allergic manifestations appear, the procedure is not carried out.
Immediately before the procedure (the day before) take antihistamines. Sometimes it is also required to take tranquilizers, but only as directed by a doctor. 8 hours before the examination, stop eating, and 4 hours before the angiography do not drink water. Before being sent to a medical facility, you need to swim and shave the puncture or catheterization site. All metal objects must be removed before the examination.
Some nuances
There are several nuances of how cerebral angiography is performed. Before the procedure, the patient will need to sign a consent to this examination. Next, a catheter is inserted intravenously. CT and MR techniques involve its introduction into a vein at the elbow bend. For 20-30 min. Before the procedure, a number of drugs are administered. These are painkillers, antihistamines and tranquilizers. itsignificantly reduces discomfort.
After that, the patient takes a horizontal position. His pulse and pressure are constantly measured with the help of special equipment. Next, the skin is treated with an anesthetic and a puncture of the carotid or vertebral artery is performed. It's pretty hard to get into them. Therefore, the femoral artery is punctured more often. The catheter is passed to the site of the study. This is a painless procedure, as the vessels inside do not have nerve endings.
Next, a contrast agent is injected, heated to body temperature (volume 8-10 ml). During this, a metallic taste may appear in the mouth. Blood rushes to the face, sweating increases. This is fine. This will pass in a few minutes. They take pictures. The doctor immediately evaluates them. If additional diagnostics are needed, another portion of the substance is injected and the procedure is repeated in the desired perspective. Then the catheter is removed, a bandage is applied. The patient is observed for 6-10 hours. Then you can go home.
Having considered the features of angiography of cerebral vessels, you can get an idea about this procedure.
