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Cerebral Angiogram

Cerebral angiography is a procedure that doctors use to image blood vessels in the brain. This allows your physician to determine whether the vessels are diseased, narrowed, enlarged or blocked altogether. This procedure can help diagnose blockages, aneurysms and other abnormalities of the blood vessels.

With this information, our physicians can recommend a course of treatment you need and how it should be performed. The angiogram is a minimally invasive procedure. A catheter (long, thin, flexible plastic tube) is placed into your leg and is guided through the blood vessels of the body to reach the neck and head. An x-ray dye is injected to highlight the vessels simultaneously when films are taken from several angles. The procedure is done in the angiography suite with a special team of physicians, physician assistants, nurses and technologists.

Why do I Need to Have a Cerebral Angiogram?

Common reasons to do a cerebral angiogram include the following:

  • show narrowing or blockages of blood vessels
  • show abnormally dilated blood vessels
  • show bleeding sites
  • display atherosclerotic disease (hardening of blood vessels) inside the head or neck
  • to find intracranial aneurysms (abnormal outpouchings of the vessel wall) or other disorders of the blood vessels inside the brain
  • planning for a future operation to decide on the best surgical procedure
  • allow interventional neuroradiologists to plan for future procedures

Preparing for a Cerebral Angiogram

  • Do not eat or drink anything after midnight the day before your procedure except for small sips of water to take your pills.
  • Prior to the procedure, you will be asked to put on a hospital gown and remove any jewelry around your head and neck that would interfere with the x-ray beam.
  • A small amount of blood will be drawn to make sure your kidneys are working and your blood it clotting normally. (If you are a female of child-bearing age, a blood pregnancy test will be done to make sure you are not pregnant as x-rays and x-ray dye could be harmful.)
  • You should not drive for 24 hours after the study.
  • Prior to the procedure, you will need to give your informed consent. This means you will speak face-to-face with the physician or physician assistant and acknowledge the potential risks and benefits of the procedure. This is also your opportunity to have any questions answered about the procedure. Your physician or PA will explain the risks of cerebral angiography in order to investigate your symptoms and plan appropriate treatment.

What Will I Experience During the Procedure?

First, the skin at the access site (usually the right groin) will be cleaned and shaved. Then a small dose of pain medication is given through the IV line during the procedure.

The skin where the catheter will be placed will be numbed beforehand. This may sting briefly but usually makes the rest of the procedure pain free. The neuroradiologist then threads the catheter (long, flexible, plastic tube) through the arterial system to the desired location and then injects the contrast (x-ray dye). During the procedure, you will not feel the catheter in the artery but when the contract material is injected, you may have a sense of warmth. X-rays are taken once the contrast is injected.

After the angiogram is completed, the catheter is removed and the puncture site closed. The incision site can be closed either by manual compression or by using a special closure device.

You will have to lie flat for 2-6 hours after angiography, depending on the reason for the test, the catheter size, and the type of device used to close up the artery. During this time, you should inform the nurse if you notice any bleeding, bruising, swelling or pain at the site where the catheter entered the skin. The entire procedure may take between one hour to several hours long.

Benefits of Cerebral Angiography

Cerebral angiography is a very detailed, clear and accurate picture of the blood vessels in the brain.  This is especially helpful when a surgical procedure or a neuroradiologic intervention is being considered.

By selecting the arteries using a catheter, it allows physicians to assess only the blood vessels

Unlike computed tomography (CT) or magnetic resonance imaging (MR) angiography, the use of a catheter makes it possible to combine diagnosis and treatment into one procedure. An example is finding an area of severe arterial narrowing, followed by angiography and placement of a stent.

The degree of detail displayed by catheter angiography cannot be obtained with any other noninvasive procedure.

Risks of Cerebral Angiography

Some patients can have an unusual allergic reaction to the contrast. Reactions range from mild skin irritation, itching, a drop in blood pressure, difficulty breathing, and loss of consciousness or death. These reactions only happen in approximately 1/50,000 to 1/150,000 people. You should tell your doctor of a previous allergy prior to this test.

There is a very tiny risk that blood will form a clot around the tip of the catheter, blocking the artery and causing a stroke. The chance of developing a permanent stroke (weakness, numbness or paralysis) as the result of a cerebral angiogram is approximately 0.5%.

If you have diabetes or kidney disease, the kidneys could be injured when contrast material is eliminated through the urine.

Very rarely, the catheter can injure the vessel wall.

Very rarely, the blood vessel the catheter was inserted into becomes blocked and prevents blood from going to your lower leg and foot. This requires an emergency operation to reopen the blocked blood vessel.

Delayed bleeding at the site of catheter insertion is very uncommon but it is the major reason that you are observed for 4-6 hours after your test is completed.

With interventional radiology procedures using x-rays, the level of risk depends on the type of procedure because some use very little radiation, while complex procedures use more.

Woman should always inform their doctor if there is any possibility that they are pregnant.