Cerebral Angiography

What is cerebral angiography?

Cerebral angiography is a procedure that allows your doctor to take a picture or image (an angiogram) of the blood vessels in your brain. Doctors use cerebral angiography to study blood vessels in your brain that are obstructed, blocked, narrowed, enlarged or malformed, and diagnose the underlying cause.

Cerebral angiography is only one method used to diagnose a variety of cerebrovascular diseases, disorders and conditions.You should discuss different screening options with your doctor or healthcare provider to best understand which option is right for you. 

Types of cerebral angiography

The types of cerebral angiography procedures include:

• Cerebral angiography is an angiographic procedure that involves inserting a catheter into a blood vessel in your groin or arm. The catheter wire is then fed, or guided to the area in the brain to be examined. X-rays are used to produce the angiogram, or picture of the vessel.  Contrast or dye is injected into the catheter to produce images of the blood vessels in your brain.
• Noninvasive cerebral angiography uses computed tomography (CT) or magnetic resonance imaging (MRI) to produce the angiogram. MRI of blood vessels is also called magnetic resonance angiography, or MRA. CT involves X-rays but MRA does not.

A cerebral angiogram, and in some cases, noninvasive cerebral angiography, use a contrast agent, sometimes called a dye. This is given intravenously (through an IV). The contrast agent greatly improves the quality of the image produced.

Why is cerebral angiography performed?

Your doctor may recommend cerebral angiography to diagnose a variety of diseases and conditions of the blood vessels in the brain including:

• Aneurysms, which are weakened or diseased areas of a blood vessel that become enlarged or bulge. Aneurysms can occur in the brain and other areas of the body and can lead to serious or life-threatening bleeding if they rupture or burst.
• Atherosclerosis, or narrowing of the arteries
• Blood clots, which may be the cause of stroke
• Blood vessel malformations, which are usually present at birth, but may become a problem at various ages from birth to adulthood
• Brain tumors. A doctor may order cerebral angiography to confirm a brain tumor or understand what blood vessels are connected to the tumor.
• Cerebrovascular disease, including stroke and transient ischemic attack (TIA, a condition in which a person has temporary stroke-like symptoms)
• Dissection or splitting of the vessels leading to the brain
• Pre-surgery evaluation. A doctor may order cerebral angiography to evaluate the blood vessels in the head and neck before brain surgery or other invasive treatment.
• Vasculitis, which is an inflammation of the blood vessels that can occur in the brain

How is cerebral angiography performed?

Your cerebral angiography will be performed in a hospital or outpatient setting by a neuroradiologist. A neuroradiologist is a physician who specializes in diagnosing diseases of the nervous system using radiological imaging. The neuroradiologist may lead a cerebral angiography team. Either a radiologist or a radiologic technologist will lead a noninvasive cerebral angiography team. The procedure takes from one to three hours and generally includes these steps:

1. You will dress in a patient gown and lie on a procedure table.
2. Your team will insert an IV to provide fluids, medications, or a contrast agent.
3. Your team will attach devices to monitor your heart rate and blood pressure.
4. Your team will position your head and may hold it in place with a strap or other device.
5. For cerebral angiography:

• Your team will take a small amount of blood for laboratory tests to verify that your kidneys are functioning properly and your blood is clotting adequately.
• Your team may give you sedative medications through the IV to help you relax.
• Your physician will determine the location to insert the catheter. The catheter is often placed in the artery in the groin . The area will be shaved, cleaned and numbed before a small incision is made. Your physician will insert the catheter and wire through the incision and guide it to the vessel to be examined.
• Once the wire is in place, your team will deliver the contrast agent through the catheter and take X-rays as the contrast agent flows through your blood vessels. You may feel a sensation of warmth when the contrast agent is injected.
• Your team will tell you when to hold still for the X-rays and may ask you to briefly hold your breath.
• When the procedure is complete, your team will remove the IV and catheter and the catheter site will be closed.