Intravenous DSA examination of patients with suspected cerebral ischemia.

Abstract

The role of i.v. digital subtraction angiography (DSA), with neck and intracranial views as a definitive pretherapy study, was analyzed in patients who had symptomatic cerebral ischemia. Patients (86), 25 of whom had subsequent carotid thromboendarterectomy, were examined. An adequate pretherapy i.v. DSA study allowed the definition of 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 i.v. DSA studies were obained 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. I.v. DSA is a valuable screening test and can be used to guide therapy in the majority of patients who have symptomatic cerebral ischemia.