Digital subtraction Neuroangiography: what a resident should know.

Abstract

Neuroangiography (NA) is an integral investigation in the management of patients with neurovascular diseases. NA is basically used for diagnosis, but in many instances, it may be followed up with treatment in the same sitting. Indications for diagnostic NA range from extracranial diseases (vertebra-basilar insufficiency from subclavian steal, extracranial carotid stenosis, cavernous-carotid fistula, neck trauma, epistaxis, etc.) to intracranial diseases (nontraumatic subarachnoid hemorrhage, cerebral aneurysms, cerebral arteriovenous malformations, cerebral vasospasm, acute stroke, etc.). A sound understanding of the principles of appropriate periprocedural care and anatomy, catheter technique, and basic disease pathology are vital for the test to be diagnostic. This pictorial review illustrates normal neurovascular anatomy along with an approach to analyze a spectrum of neurovascular pathologies and also explains a step-wise checklist for appropriate preprocedural assessment, technique of procedure, and postprocedural care of the patient. Basic knowledge on how to interpret these images and principles on how to perform it is important.