Diagnostic cerebral angiography: archaic and complication-prone or here to stay for another 80 years?

摘要

Cerebral angiography has for decades been of inestimable value in the diagnosis and evaluation of diseases of the CNS, particularlyfor vascular lesions such as aneurysms, arteriovenous malformations (AVMs) and fistulas (AVFs), CNS vasculitis, and atherosclerotic vascular disease. It has been nothing less than essential in the evaluation and treatment planning of these diseases, and it has furthered our understanding of the nature of these disease processes. However, catheter angiography remains an invasive procedure, albeit "minimally" so, involving the "unnatural" placement of catheters in very important and sometimes sensitive arteries. There is no way to entirely eliminate risk to these arteries and to the brain from this procedure, and the angiographer ponders primum non nocere when describing risk of stroke or death to the patient during the informed consent process. The focus of this review is the ongoing question: In the setting of constantly improving, utterly noninvasive CT angiography (CTA) and MR angiography (MRA) capabilities, is diagnostic cerebral angiography a brutish test of the past?