See Chapter 13.

Intra-arterial injection of iodinated contrast agent. Real-time images of contrast-filled vessels obtained via fluoroscopy. Unsurpassed for detection of stenosis, occlusion, recanalization, ulceration, dissection, aneurysm.

Disadvantages: 0.5–3% risk of embolic stroke; expensive; specialized catheter skills required.

Primary method for preoperative evaluation of intracranial aneurysms or arteriovenous malformation (AVM), especially if interventional catheter therapy is considered.

In many centers, now used only to study intracranial vascular disease not visualized by MRI, MRA, or Doppler.