What is the role of catheter angiography in the workup of basilar artery thrombosis?

Updated: Jan 11, 2019
  • Author: Salvador Cruz-Flores, MD, MPH, FAHA, FCCM, FAAN, FACP, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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With the availability of noninvasive imaging modalities such as MRI, MRA, and TCD ultrasonography, the role of angiography has changed; however, it still is considered the criterion standard. Angiography is performed (1) when MRA cannot be performed because the patient has an absolute contraindication, such as a pacemaker, or (2) when the quality of noninvasive studies is not satisfactory or the results of other tests do not explain clinical findings. (See the images below.)

Right vertebral artery angiography showing an occl Right vertebral artery angiography showing an occlusion with no flow in the basilar artery.
Angiography performed after intra-arterial thrombo Angiography performed after intra-arterial thrombolysis and angioplasty showing recanalization and perfusion of the basilar artery and its branches.

Angiography should be pursued as a first-line diagnostic test after CT scanning and once the decision is made that recanalization should be performed.

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