Intravenous digital subtraction angiography in brain ischemia.

Recent advances in computer and radiological technology have permitted a reassessment of intravenous (IV) angiography in the evaluation of extracranial and intracranial vessels. This report reviews our initial experience with IV digital subtraction angiography in the diagnosis and treatment of brain ischemia. Two hundred seventy-three IV digital subtraction angiograms (146 extracranial, 127 intracranial) were performed on a total of 178 patients with suspected cerebral ischemia (159 patients), brainstem/cerebellar ischemia (13 patients), or asymptomatic bruit (six patients). Extracranial studies clearly demonstrated ulceration, stenosis, and occlusion of the carotid arteries. Intracranial studies usually detected major artery occlusive disease and provided insight into the collateral flow patterns. Intravenous digital subtraction angiography allowed the accurate assessment of arteries after carotid endarterectomy and brain bypass surgery. Although conventional angiography was usually recommend in patients treated surgically, IV digital subtraction angiography obviated the need for conventional studies in the initial evaluation of many patients.