Neuroangiography and Stenting
Overview
Angiography is a medical term that means the visualization of blood vessels.
Neuroangiography refers to the visualization of the blood vessels of the central nervous system.
The clinical use of neuroangiography dates back to the late 1800s and early 1900s. In earlier periods, it had been solely used for diagnostic purposes, as imaging methods were not well developed, and there was no means of intravascular access. As imaging methods (computed tomography and Magnetic Resonance Imaging) have evolved, it could be possible to avoid unnecessary invasive procedures, and doctors have had the opportunity to treat vascular disorders identified in neuroangiography. On the other hand, developments in angiographic devices allowed the technique to offer more effective treatment results. At the latest stage, state-of-the-art imaging methods enable accurate diagnosis, and accordingly, neuro-angiography is primarily reserved for invasive procedures.
Today, Neuroangioraphy is a top-end invasive procedure that allows diagnosis and treatment, if possible, of vascular diseases in the central nervous system by Interventional Radiologists and Neurosurgeons. In the early evolution of neuroangiographic imaging, the cervical carotid artery was directly punctured; however, arteries of the arm and groin are now used thanks to advanced catheterization and imaging technology.
Why is this procedure done?
Neuroangiography may diagnose and treat a wide range of disorders, including both extracranial (vertebrobasilar insufficiency, stenosis of carotid artery) and intracranial (aneurysms in arteries of the central nervous system, arteriovenous malformations, stroke, tumor embolization) diseases.
Moreover, as neuro angiography is associated with severe risks (stroke, cerebral hemorrhage, air embolism, thromboembolism, transient blindness, amnesia, renal failure, and fistula), patient selection and comprehensive preparation are of great importance.
Nevertheless, since the primary goal is to minimize damage to the patient for all diseases, non-invasive imaging methods (e.g., CT and MR Angiography) are used before a neuroangiographic imaging or intervention is considered.
Risks
The possible risks of a diagnostic and therapeutic neuro angiography are listed below:
• Stroke
• Cerebral hemorrhage
• Air embolism
• Thromboembolism
• Transient blindness
• Amnesia
• Renal failure
• Fistula formation
• Reversible or irreversible damage to nervous system
• Allergic reaction against contrast agent
In the neuroangiography suite, all necessary instruments, equipment, and other means to manage the possible risks and complications are available.
Although all possible measures that modern medicine allows are taken to prevent the occurrence of risks, it is by no means likely to warrant that the risks will be eliminated.
Our specialists will employ all practices to minimize the risk of complications, and our doctors will preoperatively inform you about the risks listed above and all other potential complications and will address all your concerns.
Preparation
Several comprehensive examinations are required to decide whether neuroangiography is indicated.
Before the procedure, your health history is reviewed, and a comprehensive physical examination is done to evaluate all your vital signs (pulse, heart rate, breath rate, core temperature, etc.).
Necessary laboratory tests and radiology studies, Assessments by anesthesiologists, and other laboratory tests and radiology studies to minimize anesthesia-related complications
The time you will stop eating and drinking will be instructed. Medications you take for diabetes, hypertension, and other disorders are reviewed. You are informed about medications you should take on the day of the procedure. Besides, it would help to tell your doctor about all over-the-counter medications, herbal products, and vitamin and mineral supplements.
Since the contrast agent is used for the imaging phase of the procedure, your history is reviewed regarding allergic reactions against the contrast agent.
Moreover, it is reasonable to plan discharge, post-discharge accommodation, and travel at this phase to manage the postoperative period better.
Surgery and early postoperative period
After you have been taken to the suite for the procedure, you will be positioned on the procedure table. Mobile imaging devices can move around the table to capture images. One or even two (if intervention is planned) IV lines are inserted to allow intravenous treatments and administer medications, if necessary. At this stage, a sedative agent is administered to make you fall into a nap.
All your vital signs will be closely monitored using an ECG, pulse oximeter, and anesthesia monitor.
First, a sheath is inserted into an artery to image arteries of the central nervous system. This sheath enables quick change of catheters. Next, a hydrophilic guide wire is inserted. Then, a thin tube, called a catheter, is inserted into the artery over the guide wire. The catheter is advanced over the guide wire to the target segment. A contrast agent is administered through the lumen of the catheter, and images of the artery(ies) are captured by an imaging device and viewed on a monitor, both available in the procedure room. Intracranial navigation can also be used for neuroangiographic procedures.
Once images are captured on necessary projections, various diseases of blood vessels, such as aneurysms, malformation, stenosis, fistula, and atherosclerosis, are treated. A stent is inserted, if necessary, to maintain blood flow in the artery. If deemed appropriate, the diseased vessel is occluded by placing a clip.
The feeder artery is occluded for tumor, aneurysm, or malformation (embolization).
After the imaging and treatment phases are completed, the catheter and the guide wire are removed. The sheath, if any, is removed, and the small incision to insert the catheter is stitched.
After the neurangiography, you will be transferred to the observation room. Before moving to the patient room, you should be observed here for a while, and all your vital signs should be verified as stable or within acceptable limits. You may also be transferred to the intensive care unit if your health requires so for close monitoring.
Mainly, if the artery located in your groin is used, bleeding should be carefully monitored and managed after the neuroangiography. For this purpose, it may be necessary to apply compression on the small incision made in the groin.
Discharge after a neuro angiography is entirely related to your general health. If there is no abnormality, you will usually be discharged on the same day or the next day. But, if an abnormality has been identified and intervened, your doctor will want you to stay at the hospital for one night or longer, if necessary.
After discharge from the hospital, if you experience signs of infection such as pain, redness, and swelling at the incision site in the groin, significant swelling or bleeding at the catheter site, and if you experience chest pain or shortness of breath, it is a vital necessity to seek emergency medical treatment immediately.
Results
Neuroangiography directly visualizes arteries of the central nervous system to explore an abnormality or a problem. If a problem is identified, it is treated in the same session. However, there may be a problem that requires a major surgery, and thus, your doctors will have the opportunity to prepare you for the major surgery in elective settings.
