I have been encountering many patients and families who need cerebral angiography (DSA) for cerebrovascular disease asking me, “What is cerebral angiography all about?” “How dangerous is it?” Many patients and their family members are aware of the possible need for cerebral angiography before the consultation, but have no way to understand this knowledge, so they have doubts and even hesitation. I. When do I need DSA? DSA has been considered the gold standard for cerebrovascular imaging so far, and there is no examination (including high field intensity MRI/MRA) that is more accurate than DSA for understanding cerebrovascular lesions. in general: through DSA examination, we can accurately treat the number, location, size, morphology, and relationship with surrounding vessels of vascular lesions, and also make preliminary predictions / understand the development of the disease: the risk of bleeding, the risk of infarction, etc., whether and how to intervene, etc. DSA is needed for the following items: 1. intracranial hemorrhagic lesions, those who need to find the cause of bleeding: 2. intracranial ischemic lesions, observing the extent, degree and collateral circulation of lesions; 3. observing the development of intracranial vessels to exclude abnormalities and variants of vascular development; 4. intracranial occupying lesions, needing to understand the source of blood supply, the richness of blood supply and the relationship between lesions and important vessels; 5. understanding Certain extracranial lesions, observe their relationship with intracranial blood vessels; 6. Observe the status of intracranial vascular injury in cranial trauma. 2.How to do DSA? 1, if the patient can cooperate (have the ability to act on their own, clear consciousness) as long as local anesthesia can be done, but for restless (such as unconscious), too young, considering the examination process may move around, affecting the quality of imaging, we need general anesthesia; 2, the age of doing imaging: there is no clear age limit, that is, as long as they can tolerate can be considered DSA examination. The youngest of us has done 5 years old, and the oldest has done 95 years old. Of course, the necessary examination indicators (ECG, chest X-ray, liver and kidney function, electrolytes, coagulation function, etc.) are not obviously contraindicated before doing the examination; 3. 2-3 ml of local anesthetic drug is generally used to anesthetize the puncture point (usually about 1 cm below the groin on one side), then the femoral artery is punctured, and after the successful puncture, a special contrast tube is used to reach the neck in the arterial vessels, and the neck There are bilateral openings for the vessels supplying the head (usually six: bilateral vertebral arteries, bilateral internal carotid arteries, and bilateral external carotid arteries). We put special contrast tubes into the arterial openings about 2cm, then position them, and by injecting contrast, we can accurately know the size, shape, and the presence of lesions of the vessel. Third, the risk DSA is strictly an invasive test and cannot be considered as surgery, but as long as it is invasive, there will be risks. 1. The most common neurological complication of DSA is an ischemic event, secondary to thromboembolism or air embolism caused by catheters and guidewires. Other causes include atherosclerotic platelet rupture and vascular stragglers. Other less common neurological complications include transient skin blindness and amnesia. Very few angiograms may induce rupture of aneurysms, vascular malformations, etc. because of slight changes in intracranial pressure, but the chances are small. Current domestic and international statistics show that the overall incidence of neurological complications is 0.8% and permanent is 0.07%, meaning that 7 out of 10,000 angiography patients may develop permanent neurological dysfunction. At present, there is no case of neurological dysfunction due to angiography in our hospital; 2. Non-neurological complications: Non-neurological complications of cerebral angiography via femoral artery include: inguinal and retroperitoneal hematoma, allergic reaction, femoral artery pseudoaneurysm, lower limb thromboembolism, nephropathy, and pulmonary embolism. In the current national and international retrospective analysis of angiography, the incidence of hematoma was 0.04% and skin allergy 0.1%. The occurrence of the above cases in our hospital is slightly lower than the above data. Fourth, postoperative treatment 1, bed The lower limb on the puncture side is straightened and braked, and generally needs to be unable to bend for 24 hours, which means that the urine and stool need to be solved in bed within 24 hours. At present, there is a material specifically used to seal the postoperative vascular puncture opening, which can enable the patient to get out of bed 12 hours earlier, but the material is more expensive (about 2999 yuan), and patients can choose by themselves; 2, the puncture site and its distant segment should be checked regularly after surgery arterial pulsation in order to detect sometimes lower limb thrombosis in time, usually every 15 minutes for a total of 4 times, then every 30 minutes for a total of 2 times, and then every 1 hour for a total of 2 times. Notify the physician promptly if: (1) bleeding or hematoma formation at the puncture site; (2) distal segment pulsation at the puncture site is not palpable. 3. Vital signs monitoring: start once every 1 hour for 2 consecutive times, then once every 2 hours for 2 consecutive times, and finally change to once every 4 hours until 24 hours.