Dr. Tigran Khachatryan, MD, PhD.

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Diagnostic Cerebral Angiogram

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Understanding Your Cerebral Angiogram: A Patient Guide

A cerebral angiogram is a diagnostic procedure that helps healthcare providers detect and evaluate issues with the blood vessels in your brain. This test uses X-rays and a special dye to provide highly detailed images of these blood vessels, often much clearer than those from other imaging tests like CT or MRI scans. It is also known as digital subtraction angiography of the brain or intra-arterial digital subtraction angiography.

Indications for a Diagnostic Cerebral Angiogram

Your healthcare provider may recommend a diagnostic cerebral angiogram for several reasons, primarily to diagnose or confirm abnormalities within the blood vessels of your brain. These can include:

  • Brain aneurysm: A bulge or sac that develops in an artery due to a weak arterial wall.
  • Atherosclerosis: A narrowing of the arteries caused by cholesterol deposits or plaque.
  • Arteriovenous malformation (AVM): A tangle of dilated blood vessels that disrupts normal blood flow in the brain.
  • Dural arteriovenous fistula: Abnormal connection between arteries and veins of the brain and spinal cord membranes
  • Vasculitis: An inflammation of the blood vessels, often leading to their narrowing.
  • Vascular dissection: When the inside wall of an artery tears.
  • Stroke: Caused by a blockage of a brain artery .

The procedure can also be used to:

  • Evaluate arteries in your head and neck before surgery or other medical treatments related to your brain, head, or neck.
  • Understand how blood vessels are connected to or "feeding" a brain tumor.
  • Obtain more information about abnormalities seen on previous imaging tests, like an MRI or CT scan.
  • Help diagnose the cause of symptoms such as severe headaches, slurred speech, dizziness, blurred or double vision, weakness or numbness, or loss of coordination or balance.

Preparing for Your Cerebral Angiogram

Your healthcare provider will ensure it is safe for you to undergo the test. This usually involves a physical exam, certain blood tests, and questions about your medical history.

It is very important to tell your provider about the following:

  • All medications you are currently taking, including supplements and other over-the-counter (OTC) medications.
  • Any medical conditions you have or any recent illnesses.
  • If you have a history of bleeding problems or take blood-thinning medications, including nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Any allergies you may have, especially to anesthesia, contrast dye, or any iodine substance.
  • If you are pregnant or may be pregnant, as diagnostic cerebral angiogram involves X-ray radiation exposure.

If you are going to receive a sedative to help you relax during the procedure, your provider may instruct you not to eat or drink anything for four to eight hours before the test. If you are sedated or receiving general anesthesia, you will also need someone else to drive you home after the test.

You will receive specific instructions from your provider on how to prepare, including any necessary changes to your regular medication or eating schedule. It is crucial to follow these instructions carefully. You should leave jewelry at home and wear loose, comfortable clothing, and you will be asked to wear a medical gown. You will also be asked to empty your bladder before the procedure begins.

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What to Expect During a Cerebral Angiogram

A cerebral angiogram is a minimally invasive diagnostic procedure performed by specially trained healthcare providers in an operating room. Here’s a general overview of what you can expect:

  • You will change into a medical gown.
  • A nurse or radiologic technologist will insert an intravenous (IV) line into a vein in your hand or arm to administer a sedative, if applicable. You may feel a slight pinch when the needle is inserted. Some patients, especially children and teenagers, may require general anesthesia.
  • Devices will be attached to your body to continuously monitor your heart rate and blood pressure throughout the test.
  • You will lie on the exam table.
  • Your head will be secured with a strap, tape, or a foam head holder to ensure you remain very still during the procedure.
  • A provider will sterilize the area of your body where the catheter (a long, thin plastic tube, about 1/8 inch in diameter) will be inserted. This is usually an artery in your groin, leg, or arm, with the right radial artery in the wrist being a common first choice.
  • The provider will numb the insertion area with a local anesthetic injection, which may cause a brief burning or stinging sensation before the area becomes numb.
  • A very small skin incision will be made at the insertion site.
  • Using imaging guidance, the catheter will be inserted into an artery through a tiny hole made by a needle. You may feel some pressure when this happens, but it should not hurt.
  • The catheter will then be gently guided through the artery in your body until it reaches an artery in your neck supplying blood to the brain. You generally will not feel the catheter being guided.
  • Once the catheter is in position, the contrast material (special dye) will be injected through it. You may feel a sensation of warmth as the contrast material passes through your body, but this will quickly pass.
  • When the contrast material reaches the blood vessel(s) your provider wants to examine, several sets of X-rays will be taken. It is essential to remain very still, and you may be asked to hold your breath for 5-20 seconds during this part to ensure high-quality images.
  • After enough X-rays have been taken, the provider will remove the catheter. Pressure will be applied to your artery for a period to prevent blood pooling in the surrounding tissues (hematomaa). A closure device may be used to seal the small hole in your artery. A nurse will then cover the tiny opening in your skin with a bandage.
  • Finally, your IV line will be removed.

A cerebral angiogram typically takes one to three hours to complete, with additional time required for preparation and post-procedure care.

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After Your Cerebral Angiogram: Postoperative Care

Following the procedure, you will remain in a recovery room for observation for a few hours. Once cleared by your provider, you will be able to go home.

Your provider will give you specific instructions for your recovery, which you should follow carefully. In general:

  • You can resume your normal eating routine immediately after the exam.
  • You should rest for eight to twelve hours after the test before resuming all other normal activities.
  • If the catheter was placed in your groin area, you will receive specific instructions regarding how long you need to keep your leg straight.
  • You may apply ice to the catheter insertion site to help relieve any pain and swelling. Mild pain and discomfort are not unusual and can be managed with ice packs or low-dose nonsteroidal anti-inflammatory drugs.
  • The puncture site can be exposed to water after 48 hours, and heavy activities are generally permitted one week after the procedure.
  • There is typically no need to discontinue medications such as anticoagulants or antiplatelets before, during, or after the cerebral angiogram.
  • If you are breastfeeding, you should wait for 24 hours after the contrast material injection before resuming breastfeeding to allow the contrast to clear from your body.

When to Call Your Doctor Immediately: You should contact your provider right away if you experience any of the following symptoms after your procedure:

  • Weakness or numbness in the muscles of your face, arms, or legs.
  • Slurred speech.
  • Vision problems.
  • Signs of infection at the catheter insertion site, such as warmth, excessive redness, or discoloration.
  • Dizziness.
  • Chest pain.
  • Difficulty breathing.
  • Skin rash.

Risks and Complications

Like any medical procedure, a cerebral angiogram carries certain risks, although major complications are rare. Your provider will discuss these risks with you before the exam, and you should not hesitate to express any concerns or ask questions.

General risks associated with any procedure that places a catheter inside a blood vessel include:

  • Damage to the blood vessel, which could potentially cause internal bleeding.
  • Bruising or bleeding at the puncture site.
  • Infection.

Other risks specifically related to a cerebral angiogram include:

  • An allergic reaction to the contrast material: This is rare, and if it occurs, your radiologist is trained to treat the reaction. If you have a history of allergy to X-ray contrast material, your radiologist may advise you to take special medication for 24 hours before the procedure to lessen the risk.
  • Kidney damage due to the contrast material: This can occur, especially if you have pre-existing diabetes or kidney disease. In most cases, your kidneys will regain their normal function within five to seven days after the test.
  • A blood clot forming around the tip of the catheter: This is rare. If it happens, the clot may block your artery, and your provider may need to perform a procedure to reopen the vessel.
  • Stroke: This is a rare complication, occurring in less than 1% of cases. It can happen if the catheter dislodges plaque from a vessel wall, which could then block blood flow within your brain.
  • Radial artery spasm: This is the most common complication observed in radial access, reported in 4% to 20% of cases. It is usually mild and tolerable, and can be managed with increased sedation, analgesia, or anti-spasmolytic medications.
  • Radial artery perforation: A rare but severe complication that can lead to forearm hematoma and potentially threaten the limb.
  • Catheter kinking and knotting: Can occur during manipulation, especially in tortuous arteries.
  • Radial artery avulsion: A very rare complication that can happen during catheter removal if the catheter is tightly entrapped.
  • Post-procedural complications: Uncommon and may include radial artery occlusion, pseudo-aneurysm, arteriovenous fistulae, nerve damage, regional pain syndrome, and forearm hematoma.

There is always a slight chance of cancer from excessive exposure to radiation; however, given the small amount of radiation used in medical imaging, the benefit of an accurate diagnosis far outweighs the associated risk. Healthcare professionals take special care during X-ray exams to use the lowest radiation dose possible while producing the best images for evaluation.

Summary of Your Cerebral Angiogram

A cerebral angiogram is a minimally invasive diagnostic procedure that provides very detailed and accurate images of the blood vessels in your brain using X-rays and a special contrast dye. It is a valuable tool for diagnosing and evaluating a range of blood vessel disorders in your head, such as aneurysms, atherosclerosis, and blood clots.

The procedure involves inserting a thin tube (catheter) into an artery, typically in your wrist or groin, and guiding it to the brain’s blood vessels for imaging. Recovery typically involves a few hours of observation, with most normal activities resuming within 8 to 12 hours. While there are potential risks, like allergic reactions or bruising at the insertion site, major complications are rare. Studies have shown that radial artery access is effective and safe for diagnostic cerebral angiography, with patients often preferring this approach.

If you have any concerns about the procedure or questions, do not hesitate to ask your healthcare provider. They are available to help and support you.