Cerebral Angiography: Equipment and Contrast Agents with a Brief Overview of Fluoroscopic Physics

Purpose: The arsenal of cerebral angiography encompasses a wide variety of equipment, including guidewires, sheaths, catheters, and dilators. Equipment, contrast agents, and fluoroscopic views will be demonstrated in a table format. A brief discussion on basic cerebral angiogram will include a step-by-step approach from the basics of obtaining arterial access to the various projections involved in each great vessel. Complications as well as certain common and interesting intracranial pathologies will be demonstrated on angiograms.

Materials and Methods: Indications include aneurysm coiling, dural arteriovenous malformation (AVM) treatment via embolization, angioplasty and stenting, epistaxis treatment, trauma or tumor embolization, and stroke recanalization. Needle access gauge diameters and their significance will be discussed, and an overview will be provided of sheaths, catheters, and dilators. The H1 or Headhunter tip catheter used for femoral approach to brachiocephalic vessels will be discussed. The Simmons catheter is used for sharply angulated vessels. The C2 or Cobra catheter has an angled tip joined to a gentle curve, used primarily in celiac, renal, and mesenteric arteries. The Judkin’s catheters with lesser and greater curves can be used for right and left coronary arteries. Various guidewires include straight and J tipped, with the J tip preventing subintimal dissection of an artery. Contrast agents will be discussed. A brief overview of physics includes knowledge with regards to the fluoroscopic suite, procedure, and patient.

Results: Arterial access, catheter flush techniques, and brief summary of most commonly used catheters and guidewires with labeled visual presentation will be included. Contrast parameters for each main cerebral vessel will be demonstrated in a table format, which will include injection rate, volume, linear rate rise, and PSI. A comparison will be made between nonionic and ionic water-soluble contrast agents in addition to their osmolality, and total iodine. Fluoroscopic views will be shown table format for the great vessels, carotids, cerebral arteries, and vertebrobasilar system. Images of characteristic and common cerebral pathology will be depicted on cerebral angiography (e.g., aneurysm, cerebrovascular accident, AV malformations). Radiation physics concepts and pearls related to interventional radiology, including imaging physics, radiation dosage, and protection for proceduralist and patient, will be provided.

Conclusions: The basics of cerebral angiography include equipment, contrast usage, and fluoroscopic views that are crucial for residents and fellows to understand.