Cerebral Angiogram

What is a cerebral angiogram?

An angiogram is an X-ray of the blood vessels. It's called cerebral angiogram when done in the brain. It’s used to look for changes in the blood vessels, such as:

Ballooning of a blood vessel (aneurysm)
Narrowing of a blood vessel (stenosis)
Blockages

For an angiogram, your healthcare provider inserts a catheter into a large blood vessel and injects contrast dye. The contrast dye causes the blood vessels to appear on the X-ray image. This lets the healthcare provider better see the vessel(s) under exam.

For a cerebral angiogram, a catheter is usually inserted into an artery in the groin. Sometimes, a large artery in the arm is used. Rarely, an artery in the neck may need to be used. The groin artery is most commonly used because it’s easier to get to. The contrast dye is injected once the catheter is inserted. A series of X-rays are made next. These images show the arteries, veins, and capillaries and blood flow in the brain.

Why might I need a cerebral angiogram?

This test may be advised when previous tests don’t give enough information.

A cerebral angiogram is used to look for changes in the blood vessels within or leading to the brain. Such as:

Ballooning or bulging of a blood vessel (aneurysm)
Blood vessel narrowing (stenosis)
Narrowing of the arteries (atherosclerosis)
Inflammation of the blood vessels that narrows them (vasculitis)
Abnormal connection between the arteries and veins (arteriovenous malformation)
A blood clot within a blood vessel (thrombosis)
A spasm of the blood vessel causing an irregular narrowing of the vessel (vasospasm)
Complete blockage of a blood vessel

A cerebral angiogram may be used to locate or evaluate clips on blood vessels placed during previous surgical procedures.

Your healthcare provider may have other reasons to recommend a cerebral angiogram. Talk with your healthcare provider about the reason for your test.

What are the risks of a cerebral angiogram?

You may want to ask your healthcare provider how much radiation is used during the procedure. And about the risks related to your situation. It’s a good idea to keep a record of your history of radiation exposure. This includes previous CT scans and other types of X-rays, so that you can tell your healthcare provider. Risks linked to radiation exposure may be related to the number of X-rays or treatments over a long period.

Tell your healthcare provider if you are pregnant or think you may be. Radiation exposure during pregnancy may lead to birth defects. Special precautions will be taken to reduce the radiation exposure to the fetus if you need to have a cerebral angiogram.

There is a risk for an allergic reaction to the dye used for this test. Tell your provider if you are allergic to or sensitive to medicines, contrast dye, shellfish, or iodine. Also tell your provider if you have kidney failure or other kidney problems.

Tell your healthcare provider if you have a history of bleeding disorders. Or if you are taking blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before the procedure.

There is a small risk for complications involving the brain because the procedure involves the blood vessels and blood flow of the brain. These complications may include:

Loss of consciousness
Transient ischemic attack
Paralysis on one side of the body (hemiplegia)
Blood clot in the blood vessel (embolus)
Bleeding or bruising at the puncture site
Infection
A collection of blood and swelling (hematoma) at the site where the catheter is put in
Stroke
Loss of the ability to speak or understand speech (aphasia)

There may be other risks depending on your specific health condition. Discuss any concerns with your healthcare provider before the procedure.

How do I get ready for a cerebral angiogram?

Your healthcare provider will explain the procedure to you and ask if you have questions.
You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if anything is not clear.
Tell your healthcare provider, the radiologist, or the technologist if you:
- Have ever had a reaction to any contrast dye, or if you are allergic to iodine or shellfish
- Are sensitive to or are allergic to any medicines, latex, tape, and anesthesia (local or general)
- Are pregnant or think you may be
- Have a history of bleeding disorders or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before the procedure.
Follow any directions you are given for not eating or drinking before the procedure.
Give your healthcare provider a list of all prescribed and over-the-counter medicines and all herbs, vitamins, and supplements you are taking.
You may be given medicine to relax you and make you sleepy before the procedure. Have someone with you to drive you home if you will be going home after the procedure.
The recovery period may last up to 12 hours, depending on the site used for injection of the contrast dye. You may need to spend the night in the hospital, if necessary.
Your healthcare provider may ask for a blood test before the procedure to see how long it takes your blood to clot. Other blood tests may be done as well.
Your healthcare provider may give you other instructions on what to do before the procedure.

What happens during a cerebral angiogram?

A cerebral angiogram may be done on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your healthcare provider's practices.

Generally, a cerebral angiogram follows this process:

You will be asked to remove any clothing, jewelry, hairpins, dentures, or other objects that may get in the way of the procedure.
If you are asked to remove clothing, you will be given a gown to wear.
You will be reminded to empty your bladder before starting the procedure, which can take up to 3 hours.
You will be positioned on the X-ray table.
You will be connected to an electrocardiogram monitor that records the electrical activity of your heart. Your heart rate, blood pressure, breathing rate, and nervous system will be watched during the procedure. You will have an IV (intravenous) line put in to give you the sedative medicine.
A thin, soft tube (catheter) will be put into an artery in either your neck, arm, or groin. This is done after the skin is cleaned, you are given numbing medicine (local anesthetic), and a small cut (incision) is made.
The radiologist will check your pulses below the site if the catheter will be put into an artery in your groin or arm. They will mark them with a marker so that the circulation to the limb below the site can be checked after the procedure. In some cases, the catheter is put into an artery in your neck. If the neck is used, a pillow will be placed under your shoulders to keep your neck extended. Your head will be held in place with a strap or tape to prevent the risk of damage to the artery that might happen if you move your head. The site may be shaved before insertion of the catheter if the groin or arm is used
Once the catheter is put into the artery, it’s threaded through to an artery in the neck. A special type of X-ray (fluoroscopy) will be used to check where the catheter is inside your body.
You will be given an injection of contrast dye. The contrast dye makes the blood vessels show up on the X-ray image. This allows the healthcare provider to better see the structure of the vessel or vessels. You may feel some effects when the dye is injected into the catheter. These effects include a flushing sensation, a salty or metallic taste in your mouth, a brief headache, or nausea or vomiting. These effects usually only last for a few moments.
Tell the radiologist right away if you have any breathing difficulties, sweating, numbness, or heart palpitations.
A series of X-rays will be taken after the contrast dye is injected. The first series of X-rays shows the arteries, and the second series shows capillary and vein blood flow.
Depending on the study being done, you may have one or more injections of contrast dye.
The catheter will be removed when the test is done. Pressure will be applied over the area. Or a plug-like device will be used to keep the artery from bleeding.
After the site stops bleeding, a dressing will be applied to the site. A sandbag or other heavy item may be placed over the site. This is done to prevent further bleeding or the formation of a hematoma at the site.

What happens after a cerebral angiogram?

You may need to stay flat in bed in a recovery area for several hours after the procedure, depending on which site was used for injection of the contrast dye. If the groin or arm site was used, the leg or arm on that side will be kept straight for up to 12 hours. The healthcare staff may use ice to ease pain and swelling. You will be watched for signs of hoarseness, breathing problems, or pain or trouble swallowing if the neck was used.

A nurse will keep track of your vital signs, your neurological signs, and the injection site while you are in the recovery area.

You may be given pain medicine for pain or discomfort related to the injection site or pain from having to lie flat and still for a long period.

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

You may go back to your usual diet after the procedure, unless your healthcare provider tells you otherwise. You may go back to light activities about 8 to 12 hours after the procedure. You can resume normal activity after about 48 hours.

You may be returned to your hospital room or discharged to your home when you have completed the recovery period. Plan to have another person drive you home if this procedure was done as an outpatient.

Home care

Once home, check the injection site for bleeding. A small bruise is normal. So is an occasional drop of blood at the site.

Watch the leg or arm for changes in temperature or color, pain, numbness, tingling, or loss of function of the limb if the groin or arm was used.

Drink plenty of fluids to prevent dehydration and to help flush out the contrast dye.

You may be advised not to do any strenuous activities or take a hot bath or shower for a period after the procedure.

When should I call my healthcare provider?

Get medical attention right away if any of the following happen:

Fever or chills
Increased pain, redness, swelling, bleeding, or other drainage from the injection site
Coolness, numbness, tingling, or other changes in the affected limb
Speech or vision changes
Dizziness
Muscle weakness or numbness
Chest pain
Trouble breathing

Your healthcare provider may give you other instructions after the procedure, depending on your situation.

Next steps

Before you agree to the test or procedure make sure you know:

The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how you will get the results
Who to call after the test or procedure if you have questions or problems
How much you will have to pay for the test or procedure