CAROTID ANGIOGRAPHY

From Big Medical Encyclopedia

CAROTID ANGIOGRAPHY (Latin carotis, carotidis [arteria] carotid artery; grech, angeion a vessel + grapho to write, represent) — a method of contrast X-ray inspection of vascular system of the head, brain and neck.

Fig. 1. The diagrammatic representation of injection sites of aspirating needles (a) and catheters (b) at a carotid angiography: 1 — a humeral artery; 2 — an axillary artery; 3 — a subclavial artery; 4 — an aortic arch; 5 — the general carotid artery; 6 — an internal carotid artery (the catheter is entered through the general carotid artery); 7 — an outside carotid artery (the catheter is entered through a superficial temporal artery); 8 — an aorta (the catheter is entered through a femoral artery).

It is applied to diagnosis of anomalies of development and diseases of vascular system of bodies of a neck and the head, their tumors and some other diseases. Distinguish an angiography of outside and internal carotid arteries. To. and. it can be executed by the following methods: a direct puncture angiography of the general carotid artery, the selection angiography of outside and internal carotid arteries, the superselection — a separate angiography of brain arteries or branches of an outside carotid artery, a retrograde puncture and kateterizatsionny angiography through sleepy, humeral, axillary, subclavial (fig. 1) and femoral arteries.

For the first time To. and. on corpses it is executed by P. I. Dyakonov in 1897, and since 1927 by A. Monish it is implemented in clinic. Development To. and. in the USSR it is connected with names of S. A. Reynberg (1924), H. N. Burdenko, S. S. Bryusova (1935). The technique of administration of contrast medium and the technician rentgenol, researches are constantly improved. The puncture of an artery is carried out by a special thin-walled needle with mandrin, catheterization — by means of catheters by Seldinger's method under rentgenol, control with use of the electron-optical amplifier. (In number of 8 — 10 ml) are applied to administration of contrast mediums pneumo - or electroautomatic syringes.

To. and. it is carried out on seriograf. Angiograms make usually in direct and side, is more rare in slanting and back axial projections. For diagnosis of vascular changes the speed of shooting shall make 2 — 3 shots in 1 sec. during the first 3 — 5 sec., and at diagnosis of tumors it is necessary to do on 1 picture in 1 sec. during 7 — 10, sometimes 15 sec. For the best detailing of the small changes found on angiograms it is necessary to use a macroangiography. Improvement of diagnostic opportunities is received during the use of a method of a tomoangiografiya, and at a number of vascular defeats — a stereoangiography,

Fig. 2. Angiograms of a carotid artery (above) and schemes of angiograms (below) in side and direct projections (options of norm). The standard international designations of various departments of branches of an internal carotid artery (according to Fischer). Carotid artery: C6 — an initial part; C4 — the lower knee; C3 knee; C2 — an upper knee; C2 — C3 — C4 — a siphon of a carotid artery; C1 — final department of a siphon; About — an orbital artery; Ch — a front artery of a vascular texture. Average brain artery: M1 — an initial piece; Sq.m — an insular piece; M3 — a branching; M4 — area of an angular crinkle; M5 — trailer branchings. Front brain artery: A1 — an initial part; A2 — A3 — the ascending department with the lower bend, convex forward (A2), and an upper bend, convex forward (A3), A4 — A5 — branches in frontal (A4) and parietal (A5) areas, F — a frontal branch, With — the central branches. Back brain artery: P1 — initial department, P2 — average department, P3 — a temporal and occipital branch, P4 — a parietooccipital branch.

The data obtained at To. and., allow to judge change of blood vessels in the pool of carotid arteries, are of great importance during the studying of cerebral circulation (fig. 2), inform on localization and the sizes of a volume or vascular new growth, degree of shift of brain structures and a vklineniya of a brain, sources of blood supply patol, educations on a neck and outflow tracts of blood from them. Use X-ray cinematography (see) and video tape recording allows to use To. and. for receiving a dynamic picture of a blood-groove. To. and. it is not shown when the nature of a disease and weight of the general condition of the patient exclude a possibility of operational treatment. Relative contraindications to carrying out To. and. are available for the patients who are in critical condition with a decompensation of cardiovascular system, kidneys, a liver, an idiopathic hypertensia with systolic pressure over 250 mm of mercury., at traumatic shock of the II degree.

By preparation for a research at the patient previously make a sensitivity test to a contrast agent, for 2 days prior to a research appoint antihistaminic and spasmolytic drugs. Reception of these drugs repeats in 20 — 25 min. prior to a research. According to indications — the tranquilizers and means normalizing cordial activity. At children 7 years and adults are more senior To. and. most often carry out under local anesthesia. At the patients having epileptic seizures, excited and who are stirred up To. and. it is carried out under the general anesthesia; at a short-term research use drugs of short action (Sombrevinum, Epontolum), sometimes in combination with Seduxenum and neuroleptics, at a long research intubation Ftorotanum - a protoxidic and oxygen anesthesia is preferable.

At To. and. complications can sometimes develop: a spasm of an internal carotid artery, extensive hematomas, secondary bleedings from the place of a puncture of an artery, epileptic seizures, tranzitorny and resistant nevrol, disturbances (a hemiparesis, a hemiplegia, aphasia etc.) arising usually owing to a spasm of arteries of a brain and disturbance of cardiovascular activity (arrhythmia, a collapse and so forth). Using the latest triyodisty contrast agents allergic reactions meet seldom.


Bibliography: Arutyunov A. I. and Korniyenko V. N. Total cerebral angiography, M., 1971, bibliogr.; Kopylov M. B. Bases of radiodiagnosis of diseases of a brain, M., 1968, bibliogr.; Lebedev V. V. and d river. Radiodiagnosis of traumatic injuries of a skull and brain, M., 1973; Serbinenko F. A. Catheterization and occlusion of the main vessels of a brain and perspective of development of vascular neurosurgery. Vopr, neyrokhir., No. 5, page 17, 1971; Kgau-enbuhl H. u. Yasargil of M. of G. Die zerebrale Angiographie, Stuttgart, 1965; S a 1 a m o n G. H u a n g Y. P. Radiologic anatomy of the brain, B., 1976; Wen de S., Zieler E. a. N a k an at a-m a N. Cerebral magnification angiography, B., 1974.

Century of H. Korniyenko.

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