The Technique of Direct (Percutaneous) Cerebral Angiography

Ever since Egas Moniz, in 1927, introduced cerebral angiography, this diagnostic procedure has been adopted to a steadily increasing extent. His method consisted in exposing the internal or common carotid artery by open operation and the injection of a radio-opaque medium into the artery. In most clinics exposure of the blood vessel by operation is presumably still the prevailing technique. In 1937, Shimidzu proposed a percutaneous method, and in the German, as well as in the Scandinavian literature, this author is usually quoted as the originator of the percutaneous procedure. Loman and Myerson, however, in a paper published in 1936, had described percutaneous cerebral angiography, and had presented a number of excellent radiograms, both arteriograms and phlebograms. As early as 1919, Knauer had percutaneously injected arsphenamine into the internal carotid, in order to treat general paralysis. For seven years Loman and Myerson had already performed direct puncture of the carotid artery for various reasons, inter alia for therapeutical purposes, when it occurred to them to adopt this method for injecting thorotrast into the artery. In the literature of the English-speaking countries, more recent authors, therefore, usually refer to the work of Loman and Myerson. The use of the percutaneous method has gradually increased (Turnbull, 1939; Wolff and Schaltenbrand, 1939; Dyes, 1941; Emblem), but it seems still far from enjoying the popularity it deserves.