Understanding Brain DSA, an Examination for Cerebral Blood Vessel Abnormalities
Stroke often strikes suddenly and is the leading cause of disability and death in Indonesia. One way to reduce the risk of severe stroke is to detect cerebral blood vessel abnormalities earlier, in accordance with medical indications.
However, it should be noted that stroke can actually be prevented by detecting disorders of the brain’s blood vessels at an earlier stage. Through screening, the risk of stroke can be identified sooner so that treatment can be carried out in a timely manner. One such method is Digital Subtraction Angiography (DSA).
Dr. Muhammad Ichsan Fachrudin Firdaus, a neurosurgery specialist with a stroke intervention fellowship at Bethsaida Hospital Gading Serpong, said that DSA is an invasive radiological examination that uses contrast media to view the detailed structure of the brain’s blood vessels.
“DSA is considered the gold standard because it can display the anatomy of the brain’s blood vessels at very high resolution. From there, doctors can confirm the presence of an aneurysm, AVM, stenosis, AVF, or other vascular abnormalities that have the potential to trigger a stroke,” he explained to CNBC Indonesia on Tuesday (9/6/2026).
For information, the term gold standard refers to an examination that serves as the main reference in establishing a diagnosis because it is considered to have a high level of accuracy. In the context of examining the brain’s blood vessels, DSA is one of the reference methods because it is able to provide a detailed and real-time image of the blood vessels, thereby helping doctors determine the diagnosis and appropriate treatment plan.
DSA is suitable for patients with suspected vascular malformations (aneurysm, AV fistula), those requiring evaluation before surgery or vessel occlusion procedures (intervention), recurrent stroke without a clear cause, and preparation for endovascular procedures.
According to Dr. Ichsan, DSA is not performed for screening in healthy individuals. This examination is only considered when a patient has indications, such as suspected vascular malformations—namely aneurysm, arteriovenous malformation (AVM), and arteriovenous fistula (AVF)—based on MRI/MRA/CTA results.
It is also indicated for recurrent stroke without a clear cause after non-invasive examinations, evaluation before surgery or endovascular intervention, and evaluation of severe cerebral vessel stenosis.
The purpose of brain DSA is to identify blood vessel abnormalities in the brain such as aneurysm (widening of a blood vessel), AVM (arteriovenous malformation), stenosis (narrowing), AVF (arteriovenous fistula), and tumours that contain many blood vessels (meningioma).
“Initial examination is usually carried out using MRI, MRA, or CT Angiography. If a suspicious abnormality is found, DSA is then performed for confirmation and treatment planning,” he said.
DSA also has a therapeutic function. Once an abnormality is detected, the doctor can directly perform an endovascular procedure in the same session, such as coiling for an aneurysm, embolisation for AVM, or balloon angioplasty for stenosis.
Risks and Patient Preparation
As an invasive procedure, DSA carries a complication risk of around 0.5–1%, including haematoma at the puncture site in the thigh or arm, allergic reaction to the contrast media, impaired kidney function, or a very small risk of procedural stroke.
“Therefore, DSA has contraindications. Patients with severe kidney failure, severe contrast allergy, or blood clotting disorders require special evaluation first. The decision to perform DSA is always based on a benefit-risk assessment by the medical team,” added Dr. Ichsan.
The DSA examination itself can only be performed in hospitals that have cathlab facilities and is handled by a team of neurosurgery specialists with stroke/vascular intervention fellowships, interventional radiologists, or interventional neurologists.
For information, DSA screening can be performed at Bethsaida Hospital with increasingly modern and integrated diagnostic services. Bethsaida Hospital hopes that the public can obtain high-quality healthcare services domestically without having to seek treatment abroad.