BACKGROUND: In Canada, ancillary tests, such as selective four vessels 
angiography (S4VA), are sometimes necessary for brain death (BD) diagnosis when 
the clinical exam cannot be completed or confounding factors are present. Recent 
Canadian guidelines assert that brain death is supported by the absence of 
arterial blood flow at the surface of the brain and that venous return should 
not be considered. However, neuropathologic and angiographic studies have 
suggested that arteries might still be patent in BD patients. Current clinical 
practices in BD diagnosis following S4VA need to be better understood.
METHODS: We conducted a retrospective study of all S4VA performed for the 
determination of BD in a level 1 NeuroTrauma centre from 2003 to 2007. The 
objective of the study was to describe the prevalence of intracranial arterial, 
capillary (parenchymogram) and venous opacification in our study population. All 
tests were reviewed independently by two neuroradiologists. Disagreements were 
resolved by consensus.
RESULTS: Thirty two patients were declared BD following S4VA during the study 
period. Nine of these patients (28%) presented some proximal opacification of 
intracranial arteries (95% CI 15-45%). As opposed, none had a cerebral capillary 
and deep venous drainage opacification (95% CI 0-10%).
CONCLUSION: The absence of cerebral deep venous drainage or parenchymogram might 
represent a better objective marker of cerebral circulatory arrest for brain 
death diagnosis when the use of S4VA is required. These findings open the path 
for further research in enhancing our interpretation of angiographic studies for 
brain death diagnosis.