The role of intravenous digital subtraction angiography in the detection of the cause of cerebral ischemia

A comparative analysis of two angiography methods applied in two unrelated groups of patients with brain ischemia symptoms is described. The first group of 452 patients suffering from extracranial cerebral artery disease was analyzed by an intravenous digital subtraction angiography (DSA); the second group of 500 patients was subjected to a conventional aortic arch angiography. Research was based on comparative analysis of angiograms as per type and location of morbid changes. In the area of common carotid artery and internal carotid artery the stenosis was considerably more frequently detected by the conventional angiography than by the intravenous DSA, i.e. in 105 (20.0%) as compared to 40 (8.8%) patients, respectively. Similar difference is indicated in a total number of morbid changes in these arteries detected in 248 patients (49.6%) by aortic arch angiography and in 154 (34.1%) patients by intravenous DSA. The dissimilarity is noticed with minor atherosclerotic changes, while medium and major stenoses are detected with equal frequency by both methods. The intravenous DSA more often indicated flexion of carotid artery, and considerably more often the vertebral artery flexion as found in 53 (11.7%) patients analyzed by intravenous DSA compared to 33 (6.6%) patients analyzed by conventional angiography. Advantage of intravenous DSA is less complications and ambulatory performance. The conventional angiography better indicates morbid changes in common carotid artery bifurcation and vertebral artery origin.