CEREBRAL ANGIOGRAM

TECHNIQUE: The patient was placed supine on the angiographic table, and the right groin was prepped and draped in the usual sterile manner. The skin and subcutaneous tissues were anesthetized with 5 mL of lidocaine. Using a 5F micropuncture set the groin common femoral artery was punctured and cannulated and a 5 French arterial sheath was placed over a guidewire. The sheath was attached to continuous heparinized saline flush. A 5F diagnostic catheter was placed through the sheath and advanced over a Terumo guidewire into the aortic arch.

Selective catheterization of the following blood vessels was performed (see below). At the end of the procedure, hemostasis was achieved with a 6 French Angioseal vascular closure device.

DIAGNOSTIC ARTERIOGRAPHY AND SUPERVISION AND INTERPRETATION OF DIAGNOSTIC ARTERIOGRAMS:

RIGHT COMMON CAROTID ARTERY: The diagnostic catheter was used to select the right common carotid artery. DSA in the AP and lateral views of the cervical region were performed. The distal common, proximal internal, and imaged external carotid arteries are normal in caliber and contour. The carotid bifurcation is widely patent.

RIGHT INTERNAL CAROTID ARTERY: The catheter was advanced into the right internal carotid artery. DSA in the AP and lateral views of the intracranial circulation were performed. The intracranial segments of the right internal carotid artery are normal in course and caliber. The middle cerebral artery and its branch vessels are normal. The anterior cerebral artery and its branch vessels are normal. No evidence of aneurysm, significant stenosis, vascular malformation, or arteriovenous shunting. Dynamic imaging demonstrates a normal capillary phase. The intracranial venous structures opacify appropriately and appear patent.

RIGHT EXTERNAL CAROTID ARTERY: The catheter was advanced into the right external carotid artery. DSA in the AP and lateral views of the cranial region were performed. The visualized branches of the right external carotid artery appear normal in contour and caliber. No evidence of aneurysm, vascular malformation or arteriovenous shunting.

RIGHT VERTEBRAL ARTERY: The catheter was advanced into the right vertebral artery. DSA in the AP and lateral views of the intracranial circulation were performed. The intracranial segment of the right vertebral artery is normal in contour and caliber. Right posterior inferior cerebellar artery is normal. The basilar artery is also normal in caliber and contour. There is flash filling of the distal left vertebral artery, which is normal in appearance. The anterior inferior cerebellar and superior cerebellar arteries are unremarkable. The posterior cerebral arteries and their branch vessels are normal in caliber and contour. No evidence of aneurysm, vascular malformation, or arteriovenous shunting. Dynamic imaging demonstrates a normal capillary phase. The intracranial venous structures opacify appropriately and appear patent.

LEFT COMMON CAROTID ARTERY: The catheter was used to select the left common carotid artery. DSA in the AP and lateral views of the cervical region were performed. The distal common, proximal internal, and imaged external carotid arteries are normal in caliber and contour. The carotid bifurcation is widely patent.

LEFT INTERNAL CAROTID ARTERY: The catheter was advanced into the left internal carotid artery. DSA in the AP and lateral views of the intracranial circulation were performed. The intracranial segments of the left internal carotid artery are normal in course and caliber. The middle cerebral artery and its branch vessels are normal. The anterior cerebral artery and its branch vessels are normal. No evidence of aneurysm, significant stenosis, vascular malformation, or arteriovenous shunting. Dynamic imaging demonstrates a normal capillary phase. The intracranial venous structures opacify appropriately and appear patent.

LEFT EXTERNAL CAROTID ARTERY: The catheter was advanced into the left external carotid artery. DSA in the AP and lateral views of the cranial region were performed. The visualized branches of the left external carotid artery appear normal in contour and caliber. No evidence of aneurysm, vascular malformation or arteriovenous shunting.

LEFT VERTEBRAL ARTERY: The catheter was advanced into the left vertebral artery. DSA in the AP and lateral views of the intracranial circulation were performed. The intracranial segment of the left vertebral artery is normal in contour and caliber. The basilar artery is also normal in caliber and contour. There is flash filling of the distal right vertebral artery, which is normal in appearance. The anterior inferior cerebellar and superior cerebellar arteries are unremarkable. The posterior cerebral arteries and their branch vessels are normal in caliber and contour. No evidence of aneurysm, vascular malformation, or arteriovenous shunting. Dynamic imaging demonstrates a normal capillary phase. The intracranial venous structures opacifiy appropriately and appear patent.