What is cerebral angiography?

Cerebral angiography is a procedure in which special dye or contrast material is used with X-rays to visualize how blood flows through the brain.

During the procedure, a provider inserts a catheter, which is a thin plastic tube, into an artery in your wrist or groin area. They then inject a contrast material, which is a special dye, through the catheter to allow the structure of your blood vessels to appear. Then, the provider takes X-rays of your blood vessels as you lie on the procedure table.

These blood vessels can be visualized more in detail compared to any other imaging test for example CT scans, MRI scans.

Cerebral angiograms are also referred to as digital subtraction angiography of the brain (DSA).

Why would I need to have a cerebral angiogram?

Some cerebral angiograms are performed strictly for diagnostic purposes. In other instances, they serve as an avenue for healthcare providers to treat certain conditions.

Doctors use cerebral angiograms for a number of reasons. One of them is to investigate or confirm abnormalities in the blood vessels in your brain that include:

• Brain aneurysm.
• Atherosclerosis.
• Arteriovenous malformation.
• Dural arteriovenous fistula.
• Vasculitis.
• Vascular dissection when the inner lining of an artery tears.
• Stroke (blood clot).

Other applications include:

• Evaluation of arteries in your head and neck before surgery or other medical treatment of the brain, head, or neck.
• To observe how the blood vessel relates to or "feeds" a brain tumor.
• To learn more about abnormalities providers saw on other imaging tests, such as MRIs or CT scans.

How should I prepare for a cerebral angiogram?

Before the procedure, your health care provider will examine you and order blood tests.

Tell your provider if you:

• Have a history of bleeding problems or take medicines that are blood thinners
• Have had an allergic reaction to x-ray contrast dye or any iodine substance
• May be pregnant
• Have kidneys functioning improperly
• You might be instructed not to eat or drink liquids for around 4 to 8 hours before the test.
• When you come for the test, you will be asked to wear a hospital gown for the procedure. All body jewellery has to be removed.

What should I expect during a cerebral angiogram?

For the most part, you can expect the following from a cerebral angiogram:

• You will be attired in a medical gown.
• A nurse or radiologic technologist will insert an IV line into a vein in your hand or arm to administer a sedative if appropriate. This will feel like a small pinch. Some patients, children, and adolescents may require general anesthesia.
• A nurse or other provider will apply monitoring devices to your chest and other parts of your body to monitor your heart rate and blood pressure during the test.
• You will be positioned on the exam table.
• A provider will secure your head with a strap, tape or a foam head holder.
• A provider will clean and prepare the area of your body where they'll insert the catheter (a long, thin plastic tube) — usually in your groin, leg or arm.
• A provider will give you a local anesthetic injection to numb the area. This might feel hot or stinging for just a second as the medicine takes effect.
• The provider will make a very small skin incision at the site where they'll insert the catheter.
• Using imaging guidance, they will insert a catheter into an artery through a small puncture made by a needle. You should feel some pressure during this, but it shouldn't hurt.
• They'll then advance the catheter through one of your arteries until it reaches an artery that runs through your neck. You will not feel them advancing the catheter.
• The provider will inject the contrast material into you through the catheter. You may be sensitive to the heat as the contrast material circulates throughout your body, but this quickly fades too.
• When the contrast material reaches the blood vessel(s) your provider wishes to see, they'll take a few sets of X-rays. In some cases, you might need to hold perfectly still while taking these images or even hold your breath.
• Once you have received enough X-rays, your provider will remove your catheter. They will compress your artery for several minutes to prevent bleeding from puddling in the tissues next to your artery (hematomas). They may apply a type of closure device to your small hole in your artery. A nurse will place an over your small hole in the skin.
• A provider will remove your IV line.

What would happen after a cerebral arteriogram?

This will depend upon which site you had the contrast dye injected in, and you will spend a few hours in a recovery room laid flat out on your back. In addition to that, 12 hours after the procedure, you may need to keep the leg or arm on that side straight if that was the site injected in your groin or arm. If you had it in the neck, you will be closely monitored for hoarseness, breathing difficulty, or pain/difficulty swallowing.

As you recover from the procedure, you will be observed in the recovery area for vital signs, neurological signs, and the injection site.

You will be given pain medication for any aching or discomfort in the injection site, or for pain related to lying flat and motionless for a long time.

You will be encouraged to drink water and other fluids to help flush the contrast dye from your body.

After the procedure, you can generally return to your usual diet and activities unless your doctor or other healthcare professional instructs you otherwise.

When your recovery period is complete, you will likely be returned to your hospital room or discharged to go home. If this procedure is done as an outpatient, make arrangements to have someone drive you home from the radiology department.

How long does a cerebral angiogram take?

The length of time necessary for a cerebral angiogram can vary; however, on average it is between one to three hours. Preparation time, in addition to post-procedure care, can add time.

How long until I recover from a cerebral angiogram?

You'll need to be in the recovery room for a few hours, just in case something goes wrong with the cerebral angiogram. Then you can leave the facility and go home.

Your provider will provide you with special instructions. Be sure to follow them.

You may resume your regular diet immediately following the test and return to your normal activities eight to twelve hours after the test.

If you are breastfeeding, you must wait at least 24 hours before resuming breastfeeding after the injection of contrast media.

What are the risks of a cerebral angiogram?

Cerebral angiography carries with it a few rare but serious risks. They include:

• Stroke (if the catheter loosens plaque inside a blood vessel)
• Blood vessel damage, including puncturing an artery
• Blood clots, which can form around the catheter tip

Make sure to discuss all your risks with your doctor.

When should I call my doctor?

Call your provider immediately if you have any of the following after your procedure:

• Weakness or numbness in the muscles of your face, arms or legs.
• Slurred speech.
• Vision problems.
• Redness, warmth, or any other discoloration at the catheter insertion site, indicating a possibility of infection.
• Dizziness.
• Chest pain.
• Shortness of breath.
• Pruritic rash.

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