The current role of cerebral angiography in diagnosis of cerebrovascular disease

The role of cerebral angiography in diagnosis of cerebrovascular disease has changed considerably because of the increasing availability of neuroimaging (CT, MRI), especially MR angiography (MRA). MRA has almost entirely taken the place of cerebral angiography as a screening procedure in evaluation of the cervical carotid arteries and main trunks of intracranial arteries. However, detection of accurate morphological changes of arterial walls requires cerebral angiography, especially in cases of arteritis, arterial dissection and aneurysm of smaller than 3 mm in diameter. Cerebral angiography is still needed in order to obtain a more precise three dimensional concept of the vascular lesion, esp. in vascular malformations, their detailed blood supply, venous drainage and even for a mere (but definitive) diagnosis in some cases. Angiography is essential in preoperative surgical planning, for evaluation of residual AVM after surgery, etc. Technically, intraarterial stereoscopic DSA and serial cerebral angiography in stereoscopic magnification are most useful for angiographic diagnosis. Intravenous DSA has no advantage over MRA and is therefore no longer a useful diagnostic procedure. Cerebral angiography is also useful for evaluation of cerebral circulation which is most useful in conjunction with SPECT study. Although interventional neuroradiology has made a significant stride in the past, it requires further technical improvements and more skillful performance in the future.