Arteriography

      Conventional catheter arteriography still has a vital role in the evaluation of aneurysm and subarachnoid hemorrhage. The arteriogram is essential, first of all, to determine the site of aneurysm. CT and clinical findings can suggest the location of the aneurysm, but the arteriogram is still needed to confirm the specific location of the aneurysm. The information from the clinical and CT findings should be used to guide the sequence of vessels catheterized during the angiogram. Secondly, the angiogram must define the neck of the aneurysm so the surgeon can plan his approach for surgical

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clipping. Thirdly, it is important to identify arteries adjacent to or arising from the aneurysm. This information will also help the surgeon in positioning his clip, thus avoiding inadvertent clipping of a branch vessel. Fourthly, assessment of vasospasm is essential for planning the timing of the operation. Finally, in any patient with an aneurysm, there is a 15 - 20% chance of finding multiple aneurysms. For that reason, a three- or four-vessel angiogram should always be performed in patients with subarachnoid hemorrhage, even though an aneurysm might be found on the first vessel studied. In cases of multiple aneurysms, the angiogram may help determine which one bled. The angiographic evidence for the ruptured aneurysm includes the larger aneurysm, multilobulation and adjacent vasospasm and mass effect. Again, the CT pattern of subarachnoid blood may also suggest the site of bleeding. Endnote  

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