Sarah Lewis, PharmD
What is cerebral angiography?
Cerebral angiography is a procedure that makes a detailed picture (angiogram) of the blood vessels in the 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. Discuss all the testing options with your doctor to understand which options are right for you.
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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 the 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. This is sometimes called a dye. The dye is given intravenously (through an IV). The contrast agent improves the quality of the images.
Why is cerebral angiography performed?
Your doctor may recommend a cerebral angiography to diagnose 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 lead to serious or life threatening bleeding if they rupture or burst.
Atherosclerosis, or narrowing of the arteries
Blood clots, which can cause a stroke
Blood vessel malformations, which are usually present at birth and 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 learn 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 layers of the blood vessel walls 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
Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on cerebral angiography.
Who performs cerebral angiography?
The following specialists perform catheter cerebral angiography:
Neuroradiologists specialize in diagnosing and treating diseases of the nervous system using catheter-based procedures and imaging techniques.
Neurosurgeons specialize in the surgical care of diseases of the brain and nervous system.
Pediatric neurosurgeons specialize in the surgical care of children with diseases and conditions of the brain and nervous system.
Vascular and interventional radiologists specialize in the treatment of blood vessel and other conditions using catheter-based procedures and imaging techniques.
Vascular neurologists specialize in diagnosing and treating diseases and conditions of the blood vessels in the brain and spinal cord.
A noninvasive cerebral angiography is performed by a radiologist or a radiologic technologist. A radiologist is a doctor who specializes in diagnosing and treating diseases and injuries using medical imaging techniques. A radiologic technologist is a medical professional who is specialized in medical imaging and the care of patients during imaging procedures.
How is cerebral angiography performed?
Your cerebral angiography will be performed in a hospital or outpatient setting. The procedure takes from one to three hours and generally includes these steps:
You will dress in a patient gown and lie on a procedure table.
Your team will insert an IV to provide fluids, medications, or a contrast agent.
Your team will attach devices to monitor your heart rate and blood pressure.
Your team will position your head and may hold it in place with a strap or other device.
- For catheter cerebral angiography:
Your team will take a small amount of blood for laboratory tests to check for normal kidney function and blood clotting.
Your team may give you sedative medications through the IV to help you relax.
Your doctor 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 doctor will insert the catheter and wire through the incision and guide it to the vessel to be examined.
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 hold your breath briefly.
When the procedure is complete, your team will remove the IV and catheter and close the catheter site.
6. For noninvasive cerebral angiography:
If MRI is used, your team will give you earplugs because the machine makes loud thumping and humming noises. Closed MRI machines are long cylinders, so your team may give you a mild sedative if you are claustrophobic. The procedure table will slide into the machine for the test.
CT machines also have a tunnel, but it is much shorter than an MRI tunnel. The procedure table will slide into the machine for the test. You may need to hold your breath briefly during the imaging procedure. The CT takes about 10 minutes.
A contrast agent may be given through your IV. You may feel a sensation of warmth when the contrast agent is injected.
It is important to lie completely still during the entire procedure. Any movement may cause blurry images and require repeating the procedure. The MRI takes about an hour.
You may wait briefly while the radiologist verifies that the imaging is complete. A team member will remove your IV before you leave.
Will I feel pain?
Your comfort and relaxation is important to you and your care team. You may feel a pinch or pinprick pain during the IV placement, but the imaging itself is painless.
You will have pain and sedative medications so you stay comfortable during catheter cerebral angiography. You may have a sedative to relax you for an MRI procedure if you are claustrophobic. Tell your care team if you are uncomfortable in any way.
What are the risks and potential complications of cerebral angiography?
Complications after cerebral angiography are uncommon, but any procedure involves risks and the possibility of complications that may become serious in some cases. Complications can develop during the procedure or recovery.
Complications of cerebral angiography include:
Adverse reaction or problems related to sedation or contrast agents, such as an allergic reaction and problems with breathing
Bleeding or clotting problems
Damage to an artery from the catheter
Exposure to ionizing radiation, which may be harmful in excessive doses
Injury from metal objects in or on your body or in the room during an MRI
Kidney injury from the contrast agent, especially if you have kidney disease
Reducing your risk of complications
You can reduce the risk of some complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
Informing your doctor if you have any metal in your body, including screws, pins, plates, pacemakers, implants of any kind, intrauterine devices (IUDs), and bullet fragments
Informing your doctor if you have kidney disease or diabetes
Informing your doctor or technologist if you are nursing or there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Removing all jewelry and metal objects and leaving them outside the MRI room. This includes glasses, credits cards, hair accessories, and removable dental work.
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies, especially to iodine or shellfish
How do I prepare for my cerebral angiography?
You are an important member of your own healthcare team. The steps you take before your cerebral angiography can improve your comfort and help obtain the most accurate results.
You can prepare for cerebral angiography by:
Answering all questions about your medical history and medications. This prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Arranging for a ride home if sedation will be used during your cerebral angiography
Following any instructions about eating and drinking before cerebral angiography
Leaving jewelry, metal objects, credit cards, and other valuables at home
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. With certain types of contrast dyes, you should not take metformin (Glucophage) for 48 hours before and after your angiography. Your doctor will give you instructions about taking your medications.
Questions to ask your doctor
Having a cerebral angiography can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before a cerebral angiography and between appointments.
It is also a good idea to bring a list of questions to your appointments. Common questions include:
Why do I need cerebral angiography? Are there any other options for diagnosing or treating my condition?
How long will the procedure take? When can I go home?
What restrictions will I have after the procedure? When can I return to work and other activities?
What kind of assistance will I need at home? Will I need a ride home?
How do I take my medications?
How will you treat my pain and anxiety?
When will I receive the results of my test?
What other tests or procedures might I need?
When should I follow up with you?
When should I contact your? Ask for numbers to call during and after regular hours.
What can I expect after my cerebral angiography?
Knowing what to expect after cerebral angiography can help you get back to your everyday life as soon as possible.
How will I feel after the cerebral angiography?
You will be drowsy if you had sedative medication. It is unlikely that you will feel pain after cerebral angiography. It is common to have mild tenderness and bruising at the catheter incision site. Let a team member know if you are uncomfortable. You may have to lay flat for four to six hours after a catheter cerebral angiography.
Your activities may be restricted following a catheter cerebral angiography. Follow your doctor’s instructions for eating, drinking and resting after cerebral angiography.
When can I go home?
You will be monitored for four to six hours after a catheter cerebral angiography before going home.
You will likely go home immediately after a noninvasive cerebral angiography. If you had sedative medications, you will be discharged home when you are fully alert, breathing effectively, and your vital signs are stable. This generally takes less than an hour, depending on the type of sedation.
You cannot drive for 24 hours if you have sedation for either procedure. You will need a ride home and someone should stay with you for the first day.
When should I call my doctor?
It is important to keep your follow-up appointments after cerebral angiography. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Difficulty walking or talking or moving a body part normally
Facial weakness or facial drooping
Numbness or a feeling of coolness in the arm or leg that was used to insert the catheter
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