Portal de Periódicos da CAPES

Vertebral Angiography

1961; Radiological Society of North America; Volume: 76; Issue: 2 Linguagem: Inglês

10.1148/76.2.230

1527-1315

Robert J. Mones,

Aortic Disease and Treatment Approaches

The purpose of this report is to evaluate vertebral angiography as a diagnostic tool in neurology. It is based on 106 successful angiograms obtained in a two-year period at the Mount Sinai Hospital in New York. The methods used and the complications observed will be presented, and an analysis of the cases will be given. Method Because of its simplicity and ease of performance, the direct percutaneous anterior approach of Lindgren (1) was chosen. Before entering the Radiology Department, the patient is given atropine 0.4 mg., and Luminal 200 mg. intramuscularly. Local procaine anesthesia is used on the skin and fascia overlying the transverse processes of the cervical vertebrae. Occasionally a general anesthetic, such as intravenous Pentothal, is necessary in children or uncooperative adults. A short-bevel 18-gauge spinal needle is introduced 1 cm. from the midline, 3 cm. above the manubrium, and is angled upward for a distance of two or three vertebrae. When the vertebral body is encountered, the needle is moved laterally onto the fascia overlying the transverse processes. It is inserted between the two processes into the foramen transversum until the bony posterior wall of the foramen is felt, and then is slowly withdrawn until blood spurts back. The needle is always pointed laterally to preclude the possibility of its entering the subarachnoid space. The greatest problem is keeping the needle in place while the head and neck are positioned for the lateral and Towne projections. Six cubic centimeters of sodium diatrizoate (Hypaque) has been used routinely for each injection. With this method the amount of anesthesia, the apparatus, and personnel needed are exactly the same as for routine carotid angiography. Twelve of the 106 patients had retrograde vertebral studies in which a Cournand needle is placed in the right common carotid artery, while the distal carotid artery and the ipsilateral brachial artery are occluded mechanically. Fifteen cubic centimeters of Hypaque is injected and fills the vertebral artery via the innominate and subclavian arteries. Although others (Ameli, 2; Schaerer, 3) have had good results with this method, we have had success in only one-third of our attempts, and even in the successful studies the filling of the posterior fossa vessels is not as satisfactory as with the direct method. We therefore use the retrograde procedure only when the right carotid artery has already been cannulated for right carotid angiography. Material This study included all patients in whom vertebral arteriography was done in a two-year period. As shown in Table I, there were a total of 114 attempts at direct vertebral angiography, 80 of which were successful. During this period 14 inadvertent vertebral angiograms were obtained during the performance of routine carotid angiography.