Intra-arterial digital subtraction angiography by direct puncture using a subcutaneous needle

Intra-arterial digital subtraction angiography (IA-DSA) was obtained by direct puncture of carotid arteries using a subcutaneous needle (23G) and minimal dosage (1.5∼2.0 ml) of contrast medium in 20 patients (11 patients with cerebral aneurysm, 6 with hypertensive cerebral hemorrhage, and 3 with cerebral infarction). The quality of images obtained by this method is almost equal to that by conventional IA-DSA. Three complications including 2 periarterial injections and one subintimal injection were experienced, however, the volume of injected contrast medium was less than 1.0 ml, and there were no severe symptoms except for localized slight tenderness. This method has several advantages. They are: (a) method is simple and procedural time is short (b) no severe complications (c) imgae quality is high equal to conventional IA-DSA. Disadvantages of this method are: repeated puncture is necessary in each time of angiography taken and good sedation is required during the procedure. This method is considered useful in postoperative study after aneurysmal clipping, quick diagnosis in emergency patients with stroke, and screening test of cerebrovascular diseases. (author)