Angiography is the 'gold standard' for the investigation of cerebrovascular disease. It is often enhanced with intra-arterial digital subtraction and can be done easily in outpatients. It is indicated in the recovered stroke patient at further risk, following a TIA or RIND, and for the detection of symptomatic carotid artery stenosis. A positive ultrasound result is normally a prerequisite.
Angiography is associated with some morbidity and so should not be performed unless the result is likely to contribute materially to the management of the patient. It is contra-indicated in recent completed stroke due to either thrombosis or infarction until at least 2 weeks have passed.
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