Radiology, Vol 151, 651-659, Copyright © 1984 by Radiological Society of North America
Intravenous DSA examination of patients with suspected cerebral ischemia
WD Foley, DF Smith, MW Milde, TL Lawson, JB Towne and DF Bandyk
We analyzed the role of intravenous digital subtraction angiography (DSA),
with neck and intracranial views as a definitive pretherapy study, in
patients who had symptomatic cerebral ischemia. Eighty-six patients, 25 of
whom had subsequent carotid thromboendarterectomy, were examined. An
adequate pretherapy intravenous DSA study allowed us to define each carotid
bifurcation as either normal, having insignificant stenosis, or having
significant stenosis, and the examination excluded significant tandem
stenosis in the intracranial internal carotid arteries. Adequate pretherapy
intravenous DSA studies were obtained in 73% of patients, including 50% of
those in the presurgical group. Selective carotid arteriography was not
required in these patients. Inadequate presurgical studies were
predominantly due to plaque misregistration, inadequate projection, and
superimposition that obscured the proximal internal carotid arteries.
Selective carotid arteriography was performed in these patients prior to
surgery. Inadequate studies prior to initiation of medical therapy were
predominantly due to soft tissue misregistration artifact, and
superimposition. Intravenous DSA is a valuable screening test and can be
used to guide therapy in the majority of patients who have symptomatic
cerebral ischemia.
