Digital subtraction angiography of the arteries of the head and neck

It is readily apparent that even with the finest DSA equipment, IA-DSA offers advantages over IV-DSA and is even preferred over conventional angiography in appropriate clinical situations. Thus, at present, the authors have at their disposal three modalities for head and neck angiography: IV-DSA, IA-DSA, and conventional angiography. Intravenous studies can be performed with either peripheral or central injections of contrast medium, and IA-DSA can be done either with simple arch injections or with more selective catheterization. The indications for each type of study are still in a state of flux and vary among institutions, depending on the type of equipment available, the clinical volume and patient mix, and the personal biases of the radiologists and referring clinicians. Nonetheless, the authors will attempt to set forth certain guidelines, based mostly on personal experiences over the past 4 years with a continuously upgraded DSA system developed at our institution.