Cerebral Angiogram

What is a cerebral angiogram?

A cerebral angiogram is a diagnostic procedure that can reveal any issues with the blood vessels in your brain. Specially trained healthcare providers perform this procedure in an operating room.

During the procedure, a provider inserts a catheter (thin plastic tube) into an artery in your wrist or groin area. They then inject a contrast material (a special dye) through the catheter to show the structure of your blood vessels. Next, the provider takes X-rays of your blood vessels while you lay on the procedure table.

Cerebral angiograms can provide much more detailed images of these blood vessels than other imaging tests, like CT (computed tomography) or MRI (magnetic resonance imaging) scans.

Cerebral angiograms are also called digital subtraction angiography of the brain (DSA).

Why would I need a cerebral angiogram?

Sometimes, cerebral angiograms only have a diagnostic purpose. At other times, they allow healthcare providers to treat certain conditions.

Providers use cerebral angiograms for several reasons. One purpose is to diagnose or confirm blood vessel abnormalities in your brain, including:

• Brain aneurysm.
• Atherosclerosis.
• Arteriovenous malformation.
• Dural arteriovenous fistula.
• Vasculitis.
• Vascular dissection (when the inside wall of an artery tears).
• Stroke (blood clot).

Other uses include:

• To evaluate arteries in your head and neck before surgery or other medical treatments for your brain, head or neck.
• To see how blood vessels are connected to or “feeding” a brain tumor.
• To learn more information about abnormalities providers saw on other imaging tests, such as an MRI or CT scan.

How do I prepare for a cerebral angiogram?

In preparation for a cerebral angiogram, your healthcare provider will make sure it’s safe for you to undergo the test. They’ll likely do a physical exam, order certain blood tests and ask you questions about your medical history.

Be sure to tell your provider:

• Which medications you’re currently taking, including supplements and other over-the-counter (OTC) medications.
• If you have any medical conditions or had any recent illnesses.
• If you have a history of bleeding problems or take blood-thinning medications. This includes nonsteroidal anti-inflammatory drugs (NSAIDs).
• If you have any allergies, especially to anesthesia, contrast dye or any iodine substance.
• If you’re pregnant or may be pregnant.

If you’re going to receive a sedative (medication to keep you relaxed) during the procedure, your provider may tell you not to eat or drink anything for four to eight hours before the test. If you’re going to be sedated or are receiving general anesthesia, you’ll also need someone else to drive you home after the test.

In any case, you’ll receive specific instructions from your provider on how to prepare, including any changes you need to make to your regular medication or eating schedule. Be sure to follow them.

What should I expect during a cerebral angiogram?

In general, you can expect the following during a cerebral angiogram:

1. You’ll change into a medical gown.
2. A nurse or radiologic technologist will insert an IV line into a vein in your hand or arm to give you a sedative, if applicable. This will feel like a slight pinch. Some people, especially children and teens, may require general anesthesia.
3. A nurse or other provider will attach devices to your body to monitor your heart rate and blood pressure throughout the test.
4. You’ll lie on the exam table.
5. A provider will secure your head with a strap, tape or a foam head holder.
6. A provider will sterilize the area of your body where they’ll insert the catheter (a long, thin plastic tube) — usually in your groin, leg or arm.
7. A provider will numb the area with a local anesthetic injection. This may briefly burn or sting before the area becomes numb.
8. The provider will make a very small skin incision at the site where they’ll insert the catheter.
9. Using imaging guidance, they’ll insert a catheter into an artery through a tiny hole they make with a needle. You may feel some pressure when this happens, but it shouldn’t hurt.
10. They’ll then guide the catheter through the artery in your body until it reaches an artery in your neck. You won’t feel them guiding the catheter.
11. The provider will then inject the contrast material through the catheter. You may feel warm as the contrast material passes through your body, but this will quickly pass.
12. When the contrast material reaches the blood vessel(s) that your provider wants to examine, they’ll take several sets of X-rays. You’ll need to stay very still, even holding your breath, during this part so they can get high-quality images.
13. Once they’ve taken enough X-rays, the provider will remove the catheter. They’ll apply pressure to your artery for a certain amount of time to avoid pooling of blood in the surrounding tissues (hematomas). They may use a closure device to seal the small hole in your artery. A nurse will cover the tiny opening in your skin with a bandage.
14. A provider will remove your IV line.

How long does a cerebral angiogram take?

A cerebral angiogram usually takes one to three hours to complete. It may require additional time for exam preparation and post-procedure care.

How long is recovery after a cerebral angiogram?

After the cerebral angiogram, you’ll remain in a recovery room for observation for a few hours. After this, you’ll be able to go home.

Your provider will give you special instructions for recovery. Be sure to follow them.

You can resume your normal eating routine immediately after the exam. You should rest for eight to 12 hours after the test before resuming all other activities.

If you’re breastfeeding, you should wait for 24 hours after the contrast material injection before resuming breastfeeding.

What are the risks of a cerebral angiogram?

Any procedure that places a catheter inside a blood vessel carries certain risks, including:

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

Other risks of a cerebral angiogram include:

• An allergic reaction to the contrast material: This is rare. If it happens, your radiologist will know how to treat the reaction.
• Kidney damage due to the contrast material if you have 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 will have to operate to reopen the vessel.
• Stroke: If the catheter dislodges plaque from a vessel wall, it could block blood flow within your brain, causing a stroke. This is rare — it happens in fewer than 1% of cases.

Your provider will go over the risks of the procedure with you before the exam. Don’t hesitate to express your concerns or ask any questions.

What do the results of a cerebral angiogram mean?

Healthcare providers order cerebral angiograms for several reasons. Depending on the reason for your test, you may have different results on your report.

In general, contrast dye that flows out of a blood vessel may be a sign of bleeding.

Narrowed or blocked arteries may suggest:

• Cholesterol deposits (plaque).
• Vasospasm (brain artery spasm).
• Inherited disorders.
• Blood clots that are causing a stroke.

Out-of-place blood vessels may be due to:

• Brain tumors.
• Bleeding within your skull.
• An aneurysm.
• Arteriovenous malformation.

In any case, a radiologist will analyze the images from the test and compile a report of the findings. They’ll send the report to your provider who ordered the cerebral angiogram, who’ll then share the results with you.

You may need a follow-up exam or other tests. If so, your provider will explain why.

When should I call my doctor?

You should tell your provider immediately 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 or excessive redness or discoloration.
• Dizziness.
• Chest pain.
• Difficulty breathing.
• Skin rash.

Is a cerebral angiogram considered surgery?

A cerebral angiogram itself isn’t considered surgery. It’s a minimally invasive diagnostic procedure.

In the medical world, surgery is when a surgeon alters your body by the incision or destruction of tissues. While a cerebral angiogram involves a minor incision to place the catheter, the exam doesn’t involve changing any of your body’s tissues for medical purposes.