Efficacy and safety of digital subtraction angiography with special reference to contrast agents.

We evaluated the diagnostic accuracy and complications of digital subtraction angiography (DSA) in a series of clinical trials conducted on patients primarily with cerebral vascular disease and those evaluated before and after surgery or percutaneous transluminal angioplasty. Double-blind studies of the carotid-vertebral arteries of 300 of the 2,200 patients using DSA imaging and a variety of ionic and nonionic contrast agents showed that although subjects tolerated the injection of nonionic contrast better than ionic, nonionic contrast administration did not lead to better image quality. Of 764 patients receiving ionic contrast media, 3.3% had mild-to-serve adverse reactions; of 350 injected with nonionic contrast agents, 1.7% had mild-to-severe adverse reactions. If the sole consideration is safety, use of ionic contrast media is justified.