Title : Diagnostic cerebral and spinal digital subtraction angiography at Punjab institute of neurosciences Lahore: A single center experience
Abstract:
For cerebrovascular diseases, catheter based cerebral and spinal digital subtraction angiography (DSA) prevails as the the preferred imaging modality. The role of digital subtraction angiography is flourishing since the incorporation of diverse endovascular therapeutic approaches in the management of cerebrovascular disorders. In the developing world procedural safety protocols and reporting are not standardised. The current paper provides a review of the basic technique, demographics, indications, results and complications among 247 patients who underwent cerebral and spinal catheter angiography for diagnostic purposes in a public sector hospital.
Background:
Noninvasive vascular imaging techniques such as colour doppler ultrasound, CT angiography, and MR angiography have replaced catheter based cerebral and spinal digital subtraction angiography as a component of workup for brain and spinal vascular diseases[1-3]. In the developed countries guidelines regarding vascular imaging whether non- invasive or invasive are much more rigorous, but this is not a usual practice in developing ones [4]. In most cases, DSA can be carried out with the "intent to treat" while in others, it’s only for diagnostic purposes. Successful outcome of the procedure is largely dependent on the operator's training and expertise, disease pathology, extracranial and intracranial vascular architecture, preprocedural evaluation, and post-procedural treatment. The benefit of digital subtraction angiography is that it preserves a regular pattern by observing the three blood flow phases—arterial, capillary, and venous [5]. According to a recent European study, DSA offers more adequacy, excellence, and quality-adjusted life-years for patients with nontraumatic subarachnoid hemorrhage [6]. While both CT and MRI can reveal arteriovenous malformations (AVM), DSA is still the method of choice for analyzing the complex cerebral and spinal vasculature [7]. The complication rate related to this invasive imaging modality has significantly declined by refinement in operator expertise, innovative techniques and cutting edge technology [8–10].
Materials and Methods:
A retrospective data review of 247 consecutive diagnostic cerebral and spinal angiography exams performed by angiographers with neurosciences training background at Punjab Institute of Neurosciences (PINS), a large public sector hospital, between May 2023 and April 2024 was carried out. Prior to referral for angiography, every patient was assessed and screened to ensure the appropriateness of the indication.
Keywords: Acute Ischemic Stroke; Cerebral angiography; Spinal Angiography; Cerebrovascular Disease; Digital Subtraction Angiography (DSA); Endovascular Neurology
