Vertebral Arteriography by Retrograde Injection of the Right Common Carotid Artery

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Abstract
This report describes a simple method for obtaining vertebral arteriograms during the course of carotid arteriography. I t is a modification of a previously described “open” technic in which filling of the vertebral arterial system is accomplished by retrograde injection of contrast media into the right common carotid artery (1). The results of the present study show that vertebral arteriograms of diagnostic quality can be obtained in 70 per cent of the cases investigated. Method Vertebral arteriography by retrograde injection of the right common carotid artery is performed as follows: The patient is placed on the x-ray table, in a supine position, and the neck is hyperextended by folded sheets placed beneath the shoulders. The skin is prepared with a suitable antiseptic (Merthiolate) and a local anesthetic (1 per cent procaine or 1 per cent lidocaine) is injected into the skin and deeper cervical tissues about the common carotid artery. The position of the arteriographer is at the head of the table on the patient's left. A 17-gauge needle2 is inserted and threaded into the right common carotid artery with the point directed toward the heart. The design of the tip is such that it can be threaded easily down the artery. Connected to the needle is a plastic tube3 filled with saline containing heparin.4 The position of the needle in the neck and its relation to the bifurcation of the artery are shown in Figures 1 and 2. The injections of contrast medium are made manually, as rapidly as possible, in a retrograde direction into the right common carotid artery while an assistant maintains percutaneous compression of the artery distal to the point of puncture. A volume of 20 c.c. of 50 per cent Hypaque (sodium diatrizoate) is used for each injection. The radiographic exposure is called as the plunger strikes the bottom of the syringe. The medium flows down into the right subclavian artery and thence into the right vertebral artery as well as the other branches of the subclavian artery. A blood-pressure cuff high about the right arm is inflated to above systolic blood pressure during the injection to prevent flow of the contrast material into the brachial artery. This technic of vertebral arteriography was evaluated in a total of 60 patients with a presumptive clinical diagnosis of brain tumor, subarachnoid hemorrhage, or carotid thrombosis. Patients with marked depression of consciousness or striking neurological deficit were not included. The contrast agent used throughout the study was Hypaque. During the early phase of the study, both 50 per cent and 70 per cent Hypaque, in volumes ranging from 10 to 30 c.c., were used, the 70 per cent concentration being obtained by mixing equal quantities of 50 and 90 per cent preparations. In the majority of cases, 20 c.c. of 50 per cent Hypaque per injection was used to obtain an indirect vertebral arteriogram.

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