Digital Subtraction Angiography

In brief: Digital subtraction angiography, or DSA, is an invasive catheter angiographic technique that produces high-detail images of blood vessels and blood flow.

Use in moyamoya disease

In moyamoya disease, DSA can define the stenotic segment, basal collateral vessels, external carotid collateral routes, posterior circulation, aneurysms, potential donor vessels, and flow across an existing bypass. [1]

Contrast is injected through a catheter while rapid X-ray images are obtained. DSA is commonly described as the reference standard for detailed vascular anatomy. [1]

Current diagnostic criteria particularly emphasize angiography when lesions are unilateral or when atherosclerosis could mimic the pattern. [2] Because DSA is invasive, the expected information should justify risks such as arterial injury, contrast reaction, kidney stress, radiation, or stroke.

Clinical detail

Angiographic runs from multiple vessels and phases are needed to understand collateral supply. A single still image can misrepresent the dynamic circulation.