Cerebral angiography

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Cerebral angiography is a procedure that uses a special dye (contrast material) and x-rays to see
how blood flows through the brain.

How the Test is Performed

Cerebral angiography is done in the hospital or radiology center.

 You lie on an x-ray table.

 Your head is held still using a strap, tape, or sandbags, so you DO NOT move it during the
procedure.

 Before the test starts, you are given a mild sedative to help you relax.

 An electrocardiogram (ECG) monitors your heart activity during the test. Sticky patches,
called leads, will be placed on your arms and legs. Wires connect the leads to the ECG
machine.

An area of your body, usually the groin, is cleaned and numbed with a local numbing medicine
(anesthetic). A thin, hollow tube called a catheter is placed through an artery. The catheter is
carefully moved up through the main blood vessels in the belly area and chest into an artery in the
neck. X-rays help the doctor guide the catheter to the correct position.

Once the catheter is in place, the dye is sent through the catheter. X-ray images are taken to see
how the dye moves through the artery and blood vessels of the brain. The dye helps highlight any
blockages in blood flow.

Sometimes, a computer removes the bones and tissues on the images being viewed, so that only
the blood vessels filled with the dye are seen. This is called digital subtraction angiography (DSA).

After the x-rays are taken, the catheter is withdrawn. Pressure is applied on the leg at the site of
insertion for 10 to 15 minutes to stop the bleeding or a device is used to close the tiny hole. A tight
bandage is then applied. Your leg should be kept straight for 2 to 6 hours after the procedure. Watch
the area for bleeding for at least the next 12 hours. In rare cases, a wrist artery is used instead of the
groin artery.

Angiography with a catheter is used less often now. This is because MRA (magnetic resonance
angiography) and CT angiography give clearer images.

How to Prepare for the Test

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

Tell the 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 kidney function problems

You may be told not to eat or drink anything for 4 to 8 hours before the test.

When you arrive at the testing site, you will be given a hospital gown to wear. You must remove all
jewelry.

How the Test will Feel

The x-ray table may feel hard and cold. You may ask for a blanket or pillow.

Some people feel a sting when the numbing medicine (anesthetic) is given. You will feel a brief,
sharp pain and pressure as the catheter is moved into the body.

The contrast may cause a warm or burning feeling of the skin of the face or head. This is normal and
usually goes away within a few seconds.

You may have slight tenderness and bruising at the site of the injection after the test.

Why the Test is Performed

Cerebral angiography is most often used to identify or confirm problems with the blood vessels in the
brain.
Your provider may order this test if you have symptoms or signs of:

 Abnormal blood vessels (vascular malformation)

 Aneurysm

 Narrowing of the arteries in the brain

 Vasculitis

It is sometimes used to:

 Look at blood flow to a tumor

 Evaluate the arteries of the head and neck before surgery

 Find a clot that may have caused a stroke

In some cases, this procedure may be used to get more detailed information after something
abnormal has been detected by an MRI or CT scan of the head.

This test may also be done in preparation for medical treatment (interventional radiology procedures)
by way of certain blood vessels.

What Abnormal Results Mean

Contrast dye flowing out of the blood vessel may be a sign of bleeding.

Narrowed arteries may suggest:

 Cholesterol deposits

 A spasm of a brain artery

 Inherited disorders

Out of place blood vessels may be due to:

 Brain tumors

 Bleeding within the skull

 Bulging of a blood vessel in the brain (aneurysm)

  Abnormal connection between the arteries and veins in the brain (arteriovenous
malformation)

Abnormal results may also be due to:

 Cancer that started in another part of the body and has spread to the brain (metastatic brain
tumor)

 Syphilis infection of the brain (neurosyphilis)

Risks
Complications may include:

 Allergic reaction to the contrast dye

 Blood clot or bleeding where the catheter is inserted, which could partly block blood flow to
the leg

 Damage to an artery or artery wall from the catheter, which can block blood flow and cause a
stroke (rare)

 Damage to the kidneys from the IV contrast

Considerations
Tell your provider right away if you have:

 Weakness in your face muscles

 Numbness in your leg during or after the procedure

 Slurred speech during or after the procedure

 Vision problems during or after the procedure

Alternative Names
Vertebral angiogram; Angiography - head; Carotid angiogram; Cervicocerebral catheter-based
angiography; Intra-arterial digital subtraction angiography; IADSA
Cerebral angiography is an invasive test that involves the injection of
contrast media into the carotid artery by means of a catheter.
Radiographs are taken as the dye works its way through the cerebral
circulation. Angiography may be utilized to identify bleeding aneurysms,
vasospasm, and arteriovenous malformations, and to differentiate
embolism from large artery thrombosis [Adams HP, et al, 1994. Mohr JP,
1992]. Cerebral angiography provides information on both arteries and
veins, with sequential images showing arterial, capillary, and venous
phases.

Conventional angiography has been replaced by magnetic resonance

angiography (MRA) in some patients with cerebrovascular disease [Bruno
A, 1993]. A noninvasive test, MRA permits the visualization of blood flow
in vessels without the need for catheters or contrast agents. The
technology can yield information regarding collateral blood flow and is
nearly as effective as conventional angiography in estimating disease at
the carotid bifurcation.

This left common carotid angiogram shows complete occlusion of the left
middle cerebral artery distal to the origin of the anterior temporal branch.
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.