Cerebral angiography in stroke patients:
The contrast agent is pushed from the arterial blood vessel, and then the X-ray film is taken to analyze the condition of the cerebral blood vessel according to the development of the contrast agent in the cerebral blood vessel. This diagnostic method is cerebral angiography. Cerebral angiography includes internal carotid angiography, vertebrobasilar angiography, whole brain angiography, etc. Currently, the most commonly used is internal carotid angiography. Cerebral arteriography has definite diagnostic significance for vascular malformation, cerebral infarction, cerebral hemorrhage and cerebral aneurysm in stroke. In addition to cerebrovascular disease itself, it has a positive diagnostic effect on intracranial space occupying lesions such as intracranial tumor, traumatic intracranial hematoma and unexplained high intracranial pressure.
How to perform cerebral angiography on stroke patients?
In order to facilitate readers’ understanding, only the method of internal carotid artery angiography is discussed.
- 1.preoperative preparation. First of all, explain to the patient and his family members, explain the condition and propose the significance of this examination, and obtain the consent and signature of the family members. Commonly used contrast agents include iodopyramine, meglumine diatrizoate, sodium diatrizoate, etc. Fasting before operation, taking sedatives, and preparing necessary emergency medication.
- 2.The patient lies supine with his head stretched out on the examination table, and the doctor feels the location of the common carotid artery with his hand (the common carotid artery is the two sides of the neck laryngeal nodule, which feels pulsatile when pressed with his hand).
- 3.The puncture point is selected at 4-5 cm above the sternum and clavicular joint, the inner edge of the sternocleidomastoid muscle, and the place where the common carotid artery pulsation is obvious. The local part is routinely disinfected and covered with isolation towel.
- 4.local anesthesia should pay attention to both sides of the carotid artery. Use your left hand to find out the carotid artery and press it. Hold the needle in your right hand and stab it fiercely at an angle of 45 degrees to the skin. Then pull out the needle core and gradually return to the needle. When fresh blood is ejected, insert the needle core and extend it into the artery for fixation.
- 5.fill the syringe with 10ml of 60% meglumine diatrizoate, arrange the projection site of the patient, and the assistant should fix the patient’s head.
- 6.notify the photographer to start the injection. When the last 3 ml of the drug is left, issue the password of “take photos”, quickly push it in, and at the same time, expose and take photos. Take the right and side positions, and look at the wet film after washing. When satisfied, pull out the puncture needle and locally press to stop bleeding.
Carbon allergy, the most common complication of cerebral angiography, can be treated with antiallergic therapy. The most commonly used drugs are antihistamine drugs (such as diphenhydramine, etc.). In severe cases, high-dose adrenocorticotropic hormone (ACTH) or corticosteroid drugs (prednisone, hydrocortisone, dexamethasone, etc.) should be applied as soon as possible.
In addition, local hematoma may occur. The treatment method is local cold compress for the first 1-2 days, and then change to hot compress. Some patients and their families do not understand the significance of external application of cold first and then hot, so they use hot compress at the beginning, which makes the bleeding more serious, so they should pay attention to it in clinical practice. In some cases, epilepsy can be induced during cerebral angiography. A small amount of phenobarbital should be used to prevent epilepsy before operation. Phenobarbital should still be used to resist treatment during and after operation.
When the cerebral artery is occluded, the cerebral angiography shows that the vessel suddenly terminates and cannot be filled; When the angiographic X-ray showed avascular areas, it suggested that there were hemorrhagic foci and large hematomas in the brain; Congenital malformation of cerebral blood vessels. X-ray radiography shows piles of unformed vascular structures.
In addition, cerebral angiography can also clearly show the displacement of the anterior cerebral artery, intracranial space occupying diseases (tumors) and aneurysms.