Angiography, Digital Subtraction

Tips and Tricks

Techniques

Avoiding Complications

Air Bubble

One of the complications of cerebral angiography is ischemic stroke caused by an injected air bubble (Case 4). There are several tips to avoid such a complication.


Cases

1

Left VA Injection - PA

There is a round hypodensity (arrow) that seems to be in the transverse segment of the left VA, worrisome for an air bubble. However, it did not travel forward as the run went on. Upon further examination, it represented the junction of the bilateral VBs and was caused by the dilution of the contrast due to the competitive flow from the right VA.


2


(A): This patient presented with a supraclinoid aneurysm, which appears to be an isolated aneurysm without an adjacent branch.
(B): After flow diverter embolization, the stasis of the contrast revealed a small adjacent superior hypophyseal artery (yellow arrow).


3 - Pixel Shift


This patient underwent mechanical thrombectomy under moderate sedation for acute right ICA terminus occlusion. DSA images were blurred due to head motions (A and C). After pixel shift (B and D), the image quality significantly improved.


4 - Air Bubble

An air bubble can be seen injected into the internal maxillary artery, fortunately without causing any significant clinical complications.