Abstract
Out of 657 cases of cerebrovascular disease admitted to Mihara Memorial Hospital in past 10 months, 319 patients were subjected to the angiographic investigation. The positive pathognomonic findings definitely affirmative of the clinical manifestation were obtained in 147 cases (46%) and in 55 cases (17.5%) the supportive abnomalities were elicited.
In 61 cases of the typical cerebral hemorrhage in clinical picture, 16 cases of the intracerebral hematoma and 16 cases of the aneurysm or the A-V malformation were identified. In 171 clinically diagnosed cerebral thrombosis, the complete occlusion amounted 44 (35 in the middle cerebral artery, 8 in the internal carotid artery and 1 in the anterior cerebral artery) and more than 50% stenosis was obrerved in 12 cases (9 in the middle cerebral, 2 in the internal corotid and 1 in the anterior cerebral). Also in 68 clinically suggestive of the existence of the cerebral atherosclerosis, 44 cases disclosed various sclerotic pictures without any specific pathogenesis exclusively.
On the contrary, 7 middle cerebral occlusions and 1 intracerebral tumor were ruled out among the 35 cases of clinically diagnosed cerebral hemorrhage. In addition among 171 cases of the clinically understood cerebral thrombosis, 10 cases of the intracerebral hematoma, 5 cases of the aneurysm, 1 case of the cerebral tumor and 3 cases of the subdural hematoma were screened out. Eleven cases of aneurysm and 2 cases of the A-V malformation were picked up in this series whereas only 3 aneurysms and 2 A-V malformations were verified in 26 clinically diagnosed subarachnoid hemorrhage even by the repeated trial with various projections.
The complications due to four vessel angiography in this series were all transit and not significant. In 319 bilateral percutaneous carotid angiography and in 191 bilateral percutaneous retrograde brachial angiography for 319 patients, 1256 arterial punctures were performed and 13 complications were recorded (7 cervical subcutaneous hematoma, 3 transient chill, 1 transient weakness, 1 respiratory distress and 1 shock status).
As a conclusion, the value of the four vessel angiography for the evaluation of the clinical picture of the cerebrovascular disease can not be overestimated from our clinical experiences even with the detail and deliberate bed-side examinations.
In addition among our 319 cases, there were cases for the indication of the surgical intervention upon the retrospective analysis of the cases which could'nt be detected without the routine four vessel angiography.
