Cerebral angiography: investigating the brain's "tree of life."
The human brain has long been regarded as one of the most enigmatic subjects in both medicine and science, captivating interest since ancient times. Its intricate architecture and advanced functionalities continue to inspire awe. However, it is through the lens of contemporary medical technology that we can begin to uncover the secrets within the brain, revealing the intricate structures nestled among the blood vessels.
Cerebral angiography, a precise and advanced medical technique, illuminates the brain's vascular network, offering physicians a distinctive viewpoint. This enables them to accurately identify lesions, develop effective treatment strategies, and even create detailed surgical plans. This article aims to provide readers with a comprehensive understanding of the principles, applications, and significance of cerebral angiography in the medical field, effectively opening a window into the fascinating complexities of the brain.
What is a cerebral angiogram?
Cerebral angiography, commonly known as CBT (Cerebral Angiography), is a diagnostic technique that provides a detailed view of the vascular architecture within the brain. This method utilizes X-ray imaging technology, enabling healthcare professionals and researchers to identify abnormalities and lesions within the brain's vascular system.
Key benefits of cerebral angiography include:
The capability for superselective intravascular imaging, which reveals various lesions in intracranial blood vessels, such as aneurysms, arteriovenous malformations, arterial dissections, and instances of arterial stenosis or occlusion, while also allowing for precise measurement of affected blood vessels.
The ability to dynamically illustrate the complete time course of cerebral circulation, facilitating angiographic assessment of the blood supply to brain tissue and real-time monitoring of intracranial perfusion.
Enhanced three-dimensional imaging that provides greater detail. In cases of arterial stenosis, it can determine whether the stenosis is eccentric or concentric. For aneurysms, three-dimensional reconstruction allows for evaluation of the tumor from multiple perspectives.
General procedure of cerebral angiography
Preparation prior to the examination
The patient must complete essential physical assessments and laboratory tests to confirm eligibility for the angiography procedure.
Vascular access
The physician will identify an appropriate blood vessel for access, typically the radial or femoral artery.
Catheter insertion
A catheter will be inserted into the selected blood vessel, positioning the catheter tip at the cerebral vessel intended for examination.
Contrast agent administration
The contrast agent will be injected into the blood vessel via the catheter, while imaging studies are conducted simultaneously to monitor the contrast flow within the vessel.
Post-examination procedure
Following the examination, the physician will remove the catheter and apply pressure to the puncture site to prevent bleeding.
This procedure enables physicians to capture detailed images of the brain's vascular network, facilitating the diagnosis and monitoring of related conditions or abnormalities. This, in turn, allows for more precise treatment strategies and surgical planning, establishing cerebral angiography as an essential tool in contemporary medicine.
Applications of Cerebral Angiography
Disease Diagnosis and Monitoring: Cerebral angiography is widely used to diagnose and monitor problems in the brain's vascular system, such as aneurysms, cerebral infarction, arteriosclerosis, cerebral vascular malformations, intracranial hematomas, etc. This helps doctors determine the best treatment plan.
Surgery Planning: For patients who need brain surgery, cerebral angiography can provide precise vascular images to help surgeons plan surgical paths and reduce surgical risks.
Research and Education: Cerebral angiography is not only useful in clinical practice, but also plays a key role in medical research and medical education. It helps scientists better understand the structure and function of the brain's vascular system.
Whole brain angiography remains irreplaceable by ultrasound, CTA, or MRA examinations.
While ultrasound, CTA, and MRA can serve as preliminary screening methods prior to DSA examinations, they do not offer a complete substitute. Whole brain angiography provides a detailed visualization of the morphology of small blood vessel branches extending from the aortic arch to the brain, capable of identifying vessels with diameters as small as 1 mm. Additionally, it allows for precise assessment of the extent and severity of vascular lesions, as well as the dynamic observation of blood perfusion processes, akin to viewing a continuous film.
In summary, any vascular lesions detected through ultrasound, CTA, or MRA can be further validated or ruled out through DSA examinations.
Risks and complications of cerebral angiography
Cerebral angiography is a safe diagnostic method. According to statistics, the total complication rate of the nervous system is only 1.3%. Among them, 0.9% are transient and reversible. Complications include:
Bleeding or hematoma at the puncture site: This is the most common complication, mostly caused by improper compression and hemostasis at the puncture site or abnormal coagulation function.
Allergic reaction: Some patients are allergic to contrast agents and may experience symptoms such as rash and dyspnea.
Thrombosis: When the catheter is operated in the blood vessel, it may cause thrombosis, and the detachment of thrombus may cause embolic events.
Vascular damage: When the catheter is operated in the blood vessel, it may damage the vascular endothelium, causing vascular stenosis or occlusion.
Contrast-induced nephropathy: For patients with renal insufficiency, contrast agents may cause kidney damage. For patients with normal renal function, contrast agents are very safe.
Most complications can be prevented and controlled through routine examinations before angiography and close observation after angiography.
Postoperative rehabilitation and nursing after cerebral angiography
Care of the puncture site
After surgery, compress the puncture site to stop bleeding, and observe whether there is bleeding or hematoma at the puncture site.
Rest and activity
After surgery, patients should rest properly and avoid strenuous exercise. At the same time, when the puncture site is the femoral artery, the lower limb on the puncture side should be kept straight and immobilized for 12 hours to prevent bleeding and hematoma formation.
When the puncture site is the radial artery, the limb on the surgical side should be slightly higher after surgery, and do not sag. Generally, the radial artery compressor is removed 6 hours after surgery, and wrist flexion and weight-bearing exercises cannot be performed within eight hours. After surgery, observe whether the puncture site is swollen, tender, bleeding, etc.
Diet conditioning
After surgery, patients should maintain a light and easily digestible diet and drink plenty of water to promote the excretion of contrast agents.
Psychological adjustment
After surgery, patients may experience anxiety, tension and other emotions, and psychological counseling and prevention should be carried out in a timely manner.
Cerebral angiography is an indispensable part of modern medicine because it provides doctors with an opportunity to deeply explore the brain's vascular system. Through this technology, doctors can diagnose and treat brain vascular problems more quickly and accurately, thereby saving lives and improving patients' quality of life. At the same time, cerebral angiography also provides valuable data for research, which helps to promote the development of treatment methods and technologies for cerebrovascular diseases.
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