Cerebral angiogram

Cerebral angiogram

A cerebral angiogram is a medical procedure that uses X-rays to check blood vessels in the brain and neck. During the procedure, the doctor will insert a small tube called a catheter into an artery that leads to the brain and neck area and inject contrast media while taking X-ray images.

A cerebral angiogram consists of 4 steps as follows:

1. Inserting a catheter: a physician cleans the insertion site of the catheter, typically the groin, wrist, or fold of the arms. Under local anesthetic, the doctor will insert a catheter into the artery. The patient may feel pressure or discomfort in that area. An image of the catheter traversing up the blood vessel will appear on the X-ray monitor (like a television screen).
2. Injecting contrast media: when the catheter is in the correct position, the physician will inject the contrast agent through the catheter. An image of blood vessels appearing on the X-ray monitor will be recorded. While injecting the contrast media, the patient may feel the warmth inside the artery (lasting about 2 – 3 seconds). In some people, several injections and multiple X-ray images are necessary for a thorough diagnosis of blood vessels.
3. Removing the catheter: when the procedure is complete, the catheter will be withdrawn. The removal is not painful. The physician will apply pressure on the puncture site for 10 – 15 minutes.
4. Patients who only receive local anesthetic will be transferred to a postoperative recovery room for 30 minutes to 1-hour observation. If there is no complication they will go to ward areas for further monitoring. Patients who receive local anesthetic and sedative will be transferred to a postoperative recovery room for 2 hours of observation and to ward areas for further observation if there is no immediate complication.

The advantage of this procedure 

A cerebral angiogram produces the most detailed images of abnormalities of blood vessels in the brain and neck. With these images, physicians can provide the most accurate diagnosis and appropriate treatment plan.

Potential risks and complications

1. Bleeding
2. Infection
3. Injury at the site of punctured blood vessel
4. Reactions to contrast media
5. Acute thrombosis - if blood clots form and block the blood vessels in the brain, cerebrovascular accidents may occur; this has a very low incidence.
6. Reactions to intravenous sedation

Preparation before the procedure

1. Patients and their relatives receive information about the steps, benefits, and potential unwanted complications of the procedure.
2. Patients will be asked about their history of allergy to drugs, seafood, and preexisting diseases.
3. The physician will order a chest X-ray, blood tests to check for kidney function and blood coagulation, and EKG for patients aged 35 or older.
4. If a patient is on blood thinners such as aspirin, Plavix, and warfarin, they should inform their doctors because of the potential risk of bleeding and the need to apply prolonged pressure on the puncture site.
5. Patients will be asked to fast 6 hours before the procedure.
6. The groin insertion site will be shaved.
7. Patients must sign the consent form for the procedure.

Aftercare

1. Keep your leg straight while lying flat for at least 8 hours.
2. Inform the nurses immediately if you notice numbness, coldness, or paleness on the arm or leg with a puncture site.
3. Apply a bandage to the puncture site for 8 hours. If it bleeds, you should lie down and notify the nurses.
4. If there are no complications within 8 hours, your doctor may discharge you.
5. Rest for 24 hours after the procedure.
6. Drink a lot of fluids and return to your usual diet. After taking a shower in the first 2 – 3 days after the procedure, check for swelling or redness at the puncture site. Another complication that can happen during recovery is a delayed contrast reaction.

Alternative procedures

1. Computed Tomographic Angiography (CTA)
2. Magnetic Resonance Angiography (MRA)

Consequence of a refusal to undergo the procedure.

If the purpose of the procedure is to make a diagnosis, a refusal to undergo this procedure may cause physicians to be unable to come up with a treatment plan that is suitable and appropriate for you. Your condition may worsen, and severe complications can occur.

Advice on traveling before and after the procedure.  

Patients traveling to a hospital from the upcountry or overseas should stay at a hotel close to the hospital for at least one night after discharge. This way, it is convenient to travel to a hospital once complications occur.