Cerebral angiogram

Panorama general

A cerebral angiogram shows the blood vessels in the brain and neck. The catheter-based procedure used to make these pictures is called cerebral angiography. It is used when healthcare professionals suspect a blood vessel condition. Sometimes your care team may use cerebral angiography to map a tumor's blood supply or find out how a tumor affects nearby blood vessels.

During catheter-based cerebral angiography, a healthcare professional places a thin, flexible tube called a catheter into an artery. The catheter often is placed into the femoral artery in the groin. Sometimes the catheter goes through an artery in the wrist or the arm. Real-time X-ray images help the health professional guide the catheter to the arteries in the neck. After a contrast material is injected, X-ray images are taken as the contrast travels through the arteries, capillaries and veins of the brain. If a problem is found, treatment may be given during the same procedure.

Catheter-based cerebral angiography is different from magnetic resonance angiography (MRA) and computerized tomography angiogram (CTA) procedures. MRA and CTA take images of blood vessels without putting a catheter into an artery.

MRA uses magnetic resonance imaging (MRI) to take pictures of blood vessels in the brain, head and neck. MRA can sometimes be done without using contrast. It does not have the same risk of injuring an artery as does catheter-based cerebral angiography.

CTA uses a CT scanner and X-rays. Contrast is injected through an IV, usually in the arm. CTA can detect many blood vessel conditions, but it does not always find every one.

Catheter-based cerebral angiography can provide more detailed pictures of small blood vessels compared with MRA and CTA. It also can show changes inside a blood vessel and how blood is flowing.

Types

The types of catheter-based cerebral angiography include:

• Diagnostic cerebral angiography. This procedure may be used to diagnose a blood vessel condition or get more detail when another image is not clear or when test results do not agree. It also can be used to plan treatment or check how well an earlier treatment worked.
• Cerebral angiography with treatment. Sometimes, a healthcare professional takes angiogram images and then treats a condition through the catheter during the same procedure. The treatment may have been planned before the procedure. Or the treatment may follow once the angiogram confirms the location of the issue. An example is removing a blood clot that could cause a stroke.

Your healthcare team determines how many arteries to image depending on the medical situation.

• Limited angiography. A limited angiography looks at one or two arteries. It may be used when a healthcare professional knows the area that needs to be checked, such as during a follow-up exam after aneurysm treatment.
• Three-vessel angiography. A three-vessel angiogram takes images of the left and right common carotid arteries. These vessels are located on the sides of the neck. The common carotid artery is the main artery in the neck. The artery splits into two branches called the internal carotid artery and the external carotid artery. Three-vessel angiography also takes images of one vertebral artery, usually the left vertebral artery. It is typically used to get information about blood circulation from both carotid sides and from the back of the brain.
• Four-vessel angiography. A four-vessel angiogram takes images of both internal carotid arteries and both vertebral arteries. It may be used when the healthcare team suspects an aneurysm and needs more information about the arteries that supply blood to the brain.
• Six-vessel angiography. A six-vessel angiogram takes images of both internal carotid arteries, both external carotid arteries and both vertebral arteries. This procedure helps healthcare professionals find out whether there are blood vessel connections that are not typical. It also helps them understand the blood flow in these areas before they plan treatment.

Por qué se hace

A cerebral angiogram may be used when the healthcare team needs a detailed map of the blood vessels in the brain to make a diagnosis or choose treatment. It is often used when tests such as MRI, MRA or CTA do not give enough information, when the findings are not clear, or when the results of different tests do not agree. A cerebral angiogram can show small blood vessels, changes in blood vessels, and the speed and direction of blood flow in more detail.

A cerebral angiogram may help your care team:

• Confirm or study a brain aneurysm.
• Confirm or study an arteriovenous malformation (AVM). An AVM is a tangle of blood vessels that makes connections that are not typical between arteries and veins.
• Look for a dural arteriovenous fistula. This is a connection that is not typical between an artery and a vein in the tissue covering the brain.
• Find the cause of bleeding in or around the brain, including looking for a subarachnoid hemorrhage.
• Study possible conditions such as blood vessel narrowing, blockage, vasospasm, moyamoya disease, vasculitis, or other blood vessel diseases.
• Plan treatment, such as surgery, embolization, aneurysm coiling or clot removal for a stroke, called a mechanical thrombectomy.
• Check the result of an earlier treatment, such as aneurysm coiling or clipping or treatment of a fistula.

Cerebral angiography may be used to look at some brain tumors. A care team may consider cerebral angiography to find out whether:

• Additional details can be found when MRI or other imaging tests show a possible meningioma. A meningioma is a brain tumor that can have a rich blood supply.
• A tumor has a good blood supply.
• A tumor is affecting nearby blood vessels.
• An embolization procedure can take place or would be too risky. For example, embolization may be used to lessen blood flow to a tumor before surgery.

Riesgos

Cerebral angiography is usually considered safe when performed by an experienced healthcare team. It carries more risk than MRI, MRA and CTA procedures because a catheter goes into an artery and is guided through the blood vessels during the procedure.

Possible risks may include:

• Stroke or stroke like symptoms. Blood flow to the brain can be blocked by a blood clot, an air bubble, an injury to an artery or a loose piece of plaque inside an artery. This may cause temporary symptoms that seem like those of a stroke that go away within hours or days.
• Swelling, bleeding or bruising where the catheter enters. This could affect the groin, wrist or arm depending on where the catheter is placed. Heavy bleeding is less common.
• Groin pain. Short-term groin pain may happen if the catheter enters the femoral artery. Contact a healthcare professional right away if swelling, numbness or leg pain happen, especially pain while walking.
• Artery injury. The catheter can sometimes hurt or cause a tear inside an artery.
• Contrast reactions. Allergic reactions to contrast can sometimes happen. The risk of a reaction is typically higher if a person has kidney issues.

Risks may be higher in older adults and people with atherosclerosis, and vasculitis.

Cómo prepararte

Before a cerebral angiogram, your care team may:

• Review your medical history, symptoms and results from any previous imaging.
• Do physical and neurological exams.
• Check your blood test results, including those that look at kidney function.
• Give special instructions if you have kidney disease, a contrast allergy, or bleeding and blood clotting issues.
• Review any medicines you are taking.
• Ask you not to eat or drink for a certain amount of time before the procedure. The team lets you know whether to take medicines before the procedure.

Follow all instructions you receive from your care team.

Qué esperar

Before the procedure

You will likely lie on your back on an angiography table. The healthcare team may check your pulse in your groin or foot and do a neurological exam. The skin where the catheter will enter is cleaned and numbed with a local anesthetic. Cerebral angiograms usually are done while you are awake. You may receive mild sedation medicines to help you stay still and relax. You may have general anesthesia if treatment is planned during the procedure.

During the procedure

A healthcare professional places a small tube called a catheter into an artery, usually in the groin, but sometimes in the wrist or arm. The health professional guides the catheter through the blood vessels using live X-rays. Contrast is injected into certain arteries and then images are taken. A computer makes the blood vessels easier to see by removing bones and other tissue from the images.

You may be asked to hold very still for a few seconds while the pictures are taken.

A diagnostic cerebral angiogram typically takes less than an hour.

After the procedure

When the procedure is finished, the catheter is removed. The healthcare team stops any bleeding where the tube entered the artery. This is called the access site. The team applies pressure to the area or may use a device that helps seal the site.

Your healthcare team checks the access site and repeats a neurological exam. If you are having a diagnostic angiogram, your care team may watch you for several hours before you go home. If you had a treatment, or if you have symptoms or a complication, you may need to stay in the hospital longer.

Let your healthcare team know if you have:

• New arm or leg pain.
• Pain that happens while walking.
• A new feeling of weakness or numbness.
• Swelling or bleeding at the access site.
• A new or growing lump at the access site.

Resultados

A cerebral angiogram may show:

• Whether an artery is narrowed, blocked, or has a shape or size that is not regular.
• Whether there is an aneurysm.
• Whether there is an AVM, a dural arteriovenous fistula or another blood vessel connection that is not typical.
• Which arteries feed blood to an AVM.
• Which arteries feed blood to a tumor, especially meningiomas that are being considered for embolization.

These results often help your healthcare team decide what happens next in your treatment plan.