Online ISSN: 2515-8260

Keywords : Carotid Artery Stenting

Utility and Safety of Digital Subtraction Angiography in Management of Cerebrovascular Diseases

Dr. Hilal Ahmad Ganaie, Bashir Ahmad Sanaie, Dr. Shadab Maqsood, Dr. Adnan Raina, Feroz Shaheen, Ravouf Asimi, Dr. Sheikh Hilal, Dr. Zaffar, Dr. Sajad

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 9866-9875

Cerebral DSA is the gold standard modality of imaging in diagnosis and management of cerebrovascular diseases.
Objective: To study the utility of DSA   among the various cerebrovascular and Spino vascular diseases and  determine the  utility of DSA in patient management And study the complication related to DSA procedure.
Material And Methods: - The study was conducted in the Department of Neurology sheri Kashmir institute of medical sciences (SKIMS) and department of Neurology Super Speciality Hoapital    Shreen bagh GMC Srinagar   over a period of  3 years.  Total of 240 Neurological patients of possible vascular aetiology who had a definitive indication was taken for DSA in SKIMS/SSH GMC Srinagar. After a proper informed consent and written consent DSA where done by trained Neurointerventionist
Results : - The mean age of patients in the  study was 46 years (6-90 ) and females constituted 40 % in the study. Most of the DSA where done by short 5F Femoral Sheeth and about 30 cases DSA done by direct diagnostic catheter insertion over 0.35 Teurmo-wire after puncture without a short sheath. The mean age subjects were with mean age of 46 years (6-95 yrs). Out 240 cases of DSA 10 cases where done by Radia access and rest through femoral route In the study number and percentage of patients undergoing DSA where IS 128 (53%), HS 30 (12.5%) , SAH 48 (20%) IIH3 (1.25%) incidental aneurysma 14 (5.8%) and  CVT 8 (3.3%) , spinal angiographies 9 (3.4%) and others 8 (3.3%).. Out of 128 ischemic stroke cases , one  case underwent, DSA followed by  thrombectomy and rest 127  cases Ischemic strokes who finally underwent the DSA,   and proved symptomatic extra cranial internal carotid artery  atherosclerotic diseases  35 ( 27.30) %, symptomatic   total ICA  occlusion 30 ( 23.4%),  symptomatic intracranial atherosclerotic diseases  15 (11.7), arterial dissections were 20 (15.6%)  Common carotid artery diseases  were 3 (2.3%)  non atherosclerotic arteriopathy 15 (11.7%) where  and 10 DSA where normal. After DSA in ischemic stroke group 101 patients (78.6%) of patients where  managed medically and only  27 (21.4%) were managed with intervention. Both groups had a good out come Out of 30 cases Of ICH, DSA showed 9 patients AVM, 6 AVF, 4 aneurysms and 11 normal DSA and  Out of 48 cases of SAH 12 where having perimesyncephalic bleed and rest where 36 were aneurysmal SAH. All patients were managed according to indications.  Most of the non-neurological complications were puncture site hematoma (12.5%)  two  patients had  femoral  artery pseudo aneurysms  and where managed by local hand   compression . One patient reqired blood transfusion due to drop in hemoglobin & few  patients (6%) were  mild systemic complications  as nausea, vomiting, contrast dye allergy. Non of the patient had any TIA and stoke. We where lucky as one developed asymptomatic complete ICA  occlusion secondary  to ICA  dissection  and was successfully  managed by emergency carotid stenting.
Conclusion: DSA has good utility in management and prognosis of selected cases of neurological disorders with vascular etiology and the procedure is  safe under the hands of trained  people