What is Cerebral Angiography?

Angiography is a minimally invasive medical test that uses x-rays and an iodine containing contrast material to produce pictures of blood vessels in the brain.
In cerebral angiography, a thin plastic tube called a catheter is inserted into an artery in the leg or arm through a small incision in the skin. Using x-ray guidance, the catheter is navigated to the area being examined. Once there, contrast material is injected through the tube and images are captured using ionizing radiation (x-rays).

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How should I prepare?

You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anaesthetic medications, general anaesthesia or to contrast materials containing iodine (sometimes referred to as “dye” or “x-ray dye”). Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners for a specified period of time before your procedure. Also inform your doctor about recent illnesses or other medical conditions.

You will receive specific instructions on how to prepare, including any changes that need to be made to your regular medication schedule. You will most likely be instructed not to eat or drink anything after midnight before your procedure. Your doctor will tell you which medications you may take in the morning. Women should always inform their physician and radiographer if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the foetus to radiation.

If you are breastfeeding at the time of the exam, you should ask your radiologist if you can proceed. It may help to pump breast milk ahead of time and keep it on hand for use after contrast material has cleared from your body, about 24 hours after the test.

What will I experience during and after the procedure?

You will feel a slight pin prick when the needle is inserted into your vein for the intravenous line (IV) and when the local anaesthetic is injected. The arteries have no sensation. Most of the sensation is at the skin incision site which is numbed using local anaesthetic.

If the case is done with sedation, the intravenous (IV) sedative will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated. You may feel slight pressure when the catheter is inserted, but no serious discomfort. As the contrast material passes through your body, you may get a warm feeling. You will be asked to remain very still while the x-ray images are taken. Once the procedure is complete, the catheter will be removed by the radiologist. Pressure is immediately applied to the puncture site to ensure there is no bleeding. It takes about 10 minutes for the tiny hole in the artery to close. You may resume your normal diet immediately after the exam. You will be able to resume all other normal activities eight to 12 hours after the exam.

You should report to your physician immediately if you experience any of the following 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 site
  • dizziness
  • chest pain
  • difficulty breathing
  • rash
  • difficulty in using the extremity where the puncture/incision was made


What are the benefits vs. risks?
BENEFITS
  • Cerebral angiography presents a very detailed, clear and accurate picture of blood vessels in the brain. This is especially helpful when a surgical procedure or other treatment is being considered.
  • Results from cerebral angiography are more accurate than those produced by noninvasive imaging of the blood vessels.
  • Use of a catheter makes it possible to combine diagnosis and treatment in a single procedure.
  • No radiation remains in a patient’s body after an x-ray examination.
  • X-rays usually have no side effects in the typical diagnostic range for this exam.
RISKS
  • There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
  • There is a very slight risk of an allergic reaction if contrast material is injected.
  • If you have a history of allergy to x-ray contrast material, your radiologist may advise that you take special medication for 24 hours before cerebral angiography to lessen the risk of allergic reaction. However, the risk of an allergic reaction from contrast material injected into an artery is less than if it is introduced into a vein.
  • Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant.
  • Nursing mothers should wait for 24 hours after contrast material injection before resuming breastfeeding
  • The risk of serious allergic reaction to contrast materials that contain iodine is extremely rare, and radiology departments are well equipped to deal with them.