Superior Vena Cava Venography

• Cerebral venography is indicated for AVM, thrombus, tumor evaluation, trauma, pre/post surgical assessment, and inferior petrosal venous sampling for ACTH levels.

Superior Vena Cava Venography

• Primarily performed to rule out thrombus or occlusion.
• Contrast media gets injected through a needle or angiographic catheter in a vein located in the antecubital fossa
• Images include the opacified subclavian vein, brachiocephalic vein, superior vena cava, and right atrium.
• The mid-chest area imaged is 1” to the right side from the mid-sagittal plane.
• Typical catheter insertion uses an 18g intracath.
• Low-dose contrast injection, hand injection, and DSA are common techniques.
• Patient position is supine.
• Image quality can be improved through collimation, adjusting SID, focal spot size, and OID

Cerebrovascular Accident (CVA or Stroke)

• Risk factors include inherited blood disorders, certain cancers, medications, infections, pregnancy, and birth control.
• Symptoms include severe headache (most common), blurred vision, confusion, loss of consciousness and movement control, seizures, coma, and vein rupture causing venous hemorrhagic stroke.
• Occlusion of the anterior cerebral artery can cause contralateral loss of sensation and motor control to the lower body.
• Occlusion of the middle cerebral artery results in contralateral loss of sensation and motor control to the face and upper limbs.
• Occlusion of the posterior cerebral artery can lead to contralateral loss of vision.
• Diagnosed with CT and MRI.
• Interventional treatment options include endovascular thrombectomy, PTA, and stent placement.

CVA Medication Treatments

• Includes blood thinners for long-term treatment, IV thrombolysis with tPA (tissue Plasminogen Activator) to break down blood clots, and intravascular Thrombolysis (Fibrinolysis).
• Intravascular Thrombolysis involves suctioning thrombi into a catheter and fragmented by small jets coming out of side ports of the catheter, infusing streptokinase & urokinase.

CVA Interventional treatments

• Interventional treatments include Thrombectomy, Balloon Embolectomy (with a risk of causing PE), and Angiojet rheolytic mechanical thrombectomy
• Rt Vertebral artery occlusion can be treated with PTA & Stent Placement Procedure
• Rt. Middle Cerebral artery Occlusion can also be treated

Cerebral Aneurysm

• A true aneurysm affects all 3 layers of the arterial wall (intima, media, & adventitia).
• A false aneurysm (pseudoaneurysm) involves only the outer layer of the artery (adventitia).
• Aneurysms are classified by shape as saccular or fusiform.
• Saccular cerebral aneurysms (berry aneurysms) have a 90% occurrence.
• Aortic aneurysms are about 94% fusiform.
• Cerebral saccular aneurysms are treated with coil embolization.
• Fusiform aneurysms are most often treated with stents.

Saccular Cerebral Aneurysms Risk factors

• Advanced age, hypertension, excessive alcohol consumption, and cigarette smoking.
• Atherosclerosis of the cerebral arteries, head trauma, and the use of illicit drugs such as cocaine.
• Estrogen deficiency.

Unruptured Cerebral Aneurysm Signs and symptoms

• Headache, eye pain, unilateral complete third cranial nerve palsy.
• Ischemic/embolic cerebrovascular disease, seizures, vision loss or hemianopsia.

Arteriovenous Malformation (AVM)

• Abnormal anastomosis or communication between an artery and a vein.
• AVM Embolization is an interventional procedure used to treat AVMs with coils, plugs, glue, onyx, or absolute alcohol.

Cerebral Sinovenous Thrombosis (CSVT)

• Slow thrombi formation in a cerebral vein (CVA Stroke).
• Happens over time due to development of collaterals to bypass the obstruction.
• This rare blood clot disorder prompted the stop of Johnson & Johnson and AstraZeneca COVID-19 vaccine use.
• Risk factors include inherited blood disorders, certain cancers, medications, infections, pregnancy, birth control, and difficult birth in babies.
• Symptoms are severe headache (most common), blurred vision, confusion, loss of consciousness and movement control, seizures, coma, and vein rupture causing venous hemorrhagic stroke.
• Often misdiagnosed with CT; MR Venography is most effective.

CSVT Treatments

• Includes Blood thinners for long-term treatment.
• IV thrombolysis (tPA = tissue Plasminogen Activator = protein = breaks down blood clots).
• Intravascular Thrombolysis (Fibrinolysis) – Thrombi is suctioned into a catheter where it is fragmented by small jets coming out of side ports of the catheter, infusing streptokinase & urokinase..
• Thrombectomy, Balloon Embolectomy (risk of causing PE), and Angiojet rheolytic mechanical thrombectomy.

Dural AV Fistulogram

• It is due to cerebral sinovenous thrombosis (CSVT) or venous hypertension.
• Symptoms include severe headache, tinnitus, and confusion.
• MRI & CT modalities are used for diagnosis.
• It Is treated with embolization of feeding arteries and venous angioplasty and stent placement.

Meningioma

• Most common brain tumor.
• Primary central nervous system (CNS) tumor.
• Arises from the meninges.
• Begins in the brain or spinal cord.

Superior Vena Cava Venography is performed to rule out thrombus or occlusion. Contrast media gets injected through a vein, and images include the subclavian, brachiocephalic vein, superior vena cava, and right atrium. Low-dose contrast injection and DSA are common techniques.