Transbrachial artery approach for selective cerebral angiography in outpatients.

We examined 36 outpatients and one inpatient via the transbrachial approach (20 patients via the right brachial, 16 patients via the left). Patients' ages ranged from 18 to 86 years, with the majority in their seventh or eighth decade. Diagnoses among the outpatients included old cerebral infarction, transient ischemia attack, and seizure. The diagnosis for the inpatient was an intracranial arachnoid cyst. The femoral approach could not be used in this patient because of bilateral arteriosclerosis obliterans. Materials included a DSA system: a 4-French tight J-curved Simmons 80-cm catheter, a 19-9auge extra-thin-wall Seldinger needle, and a J/Straight floppy 125-cm guidewire. Generally, the volume of the contrast agent (300 mgl/ml iopamidol) used in the common carotid artery angiogram was 6 ml , while that used in the vertebral artery angiogram was 4 ml. If catheterization of the vertebral artery or right common carotid artery was unsuccessful , we injected the subclavian or branchiocephalic artery, using a total of 8 ml of contrast material. The patient lay in a supine position with the upper extremity extended laterally. The brachial artery at the inner side of the elbow was punctured with 19-9auge thin-walled needle and the Tefloncoated guidewire was inserted. Next, the 4-French modified Simmons catheter was advanced over the wire into the aortic arch (Fig . 1A). The catheter and the guidewire were then inserted into the left ventricle, and the catheter was reformed (Fig . 18). The reformed catheter was then withdrawn to the ascending arch of the aorta (Fig. 1 C). The right transbrachial approach is shown in Figure 2. When catheterization of the left vertebral artery was not possible, we injected the left subclavian artery (Fig . 20). The left transbrachial approach is shown in Figure 3. As catheterization of the right vertebral artery was not possible with this type of catheter, we injected the brachiocephalic artery to obtain the right vertebral angiogram (Fig. 3C). The catheter was rotated either clockwise or counterclockwise according to circumstances.