Diagnostic Cerebral Angiogram
What is Cerebral Angiography?
Cerebral angiography is a procedure that doctors use to image blood vessels in the brain. This allows your physician to diagnose narrowing or blockages of blood vessels, abnormally dilated blood vessles, atherosclerotic disease (hardening of blood vessels) inside the head or in the neck, intracranial aneurysms and other abnormalities of the blood vessels. With this information your 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 a large artery in 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 pictures are taken from several angles. The procedure is done in the angiography suite with a special team of physicians, physician assistants, nurses and technologists. The test generally lasts 1-2 hours.
Unlike computed tomography (CT) or magnetic resonance (MR) angiography, the use of a catheter makes it possible to combine diagnosis and treatment into one procedure. Additionally, the degree of detail displayed by catheter angiography cannot be obtained with any other noninvasive procedure. Although a cerebral angiogram is a valuable diagnostic tool with a low risk of complication, feelings of anxiety before and during the procedure are normal.
Risks Associated with Cerebral Angiogram
The chance of any complication with a cerebral angiogram is small. However, it is important to be aware of the possible risks, which include an allergic reaction, stroke, and hemorrhage. Of course your physician will be carefully monitoring for any complications and is fully trained to respond if one arises.
- 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, 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 history prior to iodine.
- 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 four to six 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.
This document will help to prepare you for a cerebral angiogram. It will be done in the Radiology Department at Santa Barbara Cottage Hospital by our Neuro Interventional Radiology team. You will check in at the front entrance (Pueblo and Bath) of the hospital. Prior to the procedure you will need to give your informed consent. This means you will speak with the physician or one of our Nurse Practitioners and acknowledge the potential risks of cerebral angiography in order to investigate your symptoms and plan appropriate treatment. This is also your opportunity to have any questions answered about the procedure.
Preparing for the Procedure
- Do not eat or drink anything after midnight the day before your procedure
- Patients who take medications routinely should check with their physician. If routine medication is allowed the day of the test, it should only be taken with a small sip of water.
- If you have diabetes and take insulin, we ask you to take one half (1/2) of your normal morning dose on the day of the test. If you take a medicine called Glucophage (metformin) you should NOT take it 2 days prior to the angiogram. You will not take this medication for 48 hours after the angiogram. Please tell your doctor if you are taking any oral diabetes medicines.
- It is recommended that you leave all valuables at home.
- A small amount of blood will be drawn to make sure your kidneys are working and your blood is clotting normally. If you are a female of childbearing age, a pregnancy test will be done to make sure you are not pregnant as x-rays and x-ray dye could be harmful.
- It is important to inform the angiogram technician if you have any of the following conditions: asthma, diabetes, and allergies to iodine, shellfish, drugs, or latex.
- If you are pregnant or breast-feeding, please let us know when we call to schedule the angiogram. We generally like to hold off on doing the angiogram until after the baby is delivered.
- As most people go home the same day, you should arrange to have someone drive you home after the test. You can NOT drive for 24 hours after the test. Plan to have someone stay with you that night, just in case any problems occur and you need care right away.
Prior to the angiogram
Patients are asked to change into a hospital gown and remove any jewelry around their head and neck that would interfere with the x-ray beam. Blood and urine samples are collected to make sure the patient’s kidneys are functioning well and their blood is clotting normally. An electrocardiogram (EKG) or chest x-ray is also performed. If the patient is a female of childbearing age, a pregnancy test is done to make sure they are not pregnant as x-rays and x-ray dye could be harmful. In the nursing unit, a mild sedative and fluids are administered through an IV.
When it is time for the angiogram, the patient is taken to the angiography suite and positioned on an x-ray table. The nurse connects monitors in order to closely observe the patient’s heart rate, breathing, and blood pressure. Then the patient is given medicine to help them relax. Once they are ready, the groin area just above the leg (near the hip bone and inner thigh) is shaved and then cleansed with a liquid that may feel very cold. A sterile drape is placed over most of the patient’s body and an anesthetic is used to numb that site before the small tube (catheter) is placed into the artery. This may sting briefly but usually makes the rest of the procedure pain free. The patient’s head is secured to the table with tape to keep the pictures clear.
During the Angiogram
During the test, the patient needs to lie very still in order to get the best results. The neuroradiologist directs the catheter (long flexible plastic tube) through the arterial system to the desired location and then injects the contrast (x-ray dye) several times. During the procedure the patient will not feel the catheter in the artery but when the contrast material is injected, they may have a sense of warmth on the side of their neck and face, lasting 30-60 seconds. This is a normal sensation. X-rays are taken when the contrast is injected. The clicking noise coming from the x-ray machines is normal. The patient may also notice the lights in the room turning on and off and the doctors and staff stepping out of the room temporarily while the x-rays are being taken.
After the Angiogram
After the angiogram is completed, the catheter is removed and the puncture site closed. The incision site can be closed by applying pressure for 15-20 minutes to stop bleeding, or by using a special closure device. When the bleeding stops, a thick dressing is placed on the incision. At this point the doctor will discuss the results of the test with the patient and finally proceed to the waiting room to discuss the results with the family and answer any questions they might have. The patient is then moved to an observation area where they will stay for the next 2-6 hours for their recovery, depending on the reason for the test, the catheter size, and the type of device used to close up the artery. During this time, the patient is asked to lie flat and drink plenty of fluids in order to flush the dye from their system. The nurse will constantly be checking the patient’s blood pressure, pulse, and the puncture site. The patient should inform the nurse if they notice any bleeding, bruising, swelling or pain at the site where the catheter entered the skin. When the patient is feeling okay, and is able to get up and walk, then they will be able to go home. At this point the nurse will go through the discharge instructions with the patient and their family and make sure that a responsible adult will be driving the patient home.
The Discharge Instructions should include:
- No heavy lifting, exercise, and driving for 48 hours. Do not operate machinery for at least 24 hours. It is important not to stress the incision site.
- During the next 24 hours continue to drink plenty of fluids to flush the contrast dye from the kidneys. Avoid beverages that dehydrate the body, such as alcohol or coffee.
- Resume a regular diet.
Activities for the Next Week
- You will be allowed to shower the day after the angiogram, but do not soak in a bath tub or hot tub.
- You should not do any heavy lifting (over 10 pounds).
- No vigorous activity.
- No swimming.
- You may remove the bandage over the groin the next day and gently wash the area with a mild soap and water. Do not rub this area to dry the skin. You should only ‘blot’ the area with a towel.
- If bleeding occurs at the puncture site, apply direct pressure and go to the nearest emergency room.
*Be sure to let us know if you will need a letter for work or school to excuse you from these activities.
What to Expect
- The puncture site might be tender or sore. This often goes away after a few days, but it can last up to one week.
- You may notice some bruising in your groin. This goes away after 2-3 weeks.
- Some patients feel a small hard bump about the size of a peanut at the groin site. This is normal and generally goes away after several months.
When to Call the Doctor
- If incision site becomes red and/or hot or any bleeding comes from the incision site
- If any yellow or green drainage comes from site.
- If swelling occurs at the site, or loss of feeling.
- If your temperature goes above 100°F.
- If you experience sudden confusion.
- If you have severe pain or spasm in the leg.
- Urination is difficult
- A change or loss of vision occurs
- Swallowing or talking is difficult
- If numbness or tingling occurs in the extremities (arms, legs) or face.
- If an allergic reaction develops, including itching, hives, rash, rapid heart beats, dizziness, chest pain, or shortness of breath