Cerebral Angiogram Teaching Sheet
A cerebral angiogram is a diagnostic study that uses x-ray and dye to visualize the blood vessels in the neck and brain. Angiography is particularly useful in visualizing abnormalities such as cerebral aneurysms. Angiography can also visualize blockages, leaking, or abnormal vessels.
Your neurosurgeon, specially trained in interventional radiology, will perform this procedure. Interventional neuroradiology uses catheters to treat problems in blood vessels in the brain. The problem is treated from the inside the blood vessels, or endovascularly.
The angiogram is usually an outpatient procedure. You are admitted in the morning then discharged later in the day.
What is an aneurysm?
An aneurysm is a weak spot in the wall of an artery. Most aneurysms are congenital (from birth). Some may develop from direct injury to the artery (trauma) or infection. The wall of an aneurysm is thin like a balloon and can rupture or leak blood under high pressure. An aneurysm in the head can leak high-pressure blood into the brain and spinal fluid. Symptoms may range from a severe headache and stiff neck, double vision, dizziness and/or nausea to sudden stroke-like symptoms or death.
What is a AVM?
AVM is short for, arteriovenous malformation. An AVM is a tangle of abnormal vessels. The walls of an AVM are abnormal. They are more like the walls of a vein, therefore, are weaker. AVMs can occur anywhere in the body but most commonly in the brain. Any leakage or rupture of blood into the brain or spinal fluid can cause symptoms similar to those of any aneurysm rupture.
What is Embolization?
Embolization is a way to cut off or reduce blood flow to a blood vessel abnormality that has or could rupture or leak. In addition to being a diagnostic imaging study, angiography is the first step of an embolization procedure. It “shows the way” to the vascular abnormality so that a catheter can be inserted into the vessels that need to be closed.
What is coil embolization or endovascular coiling?
Endovascular therapy is a minimally invasive procedure that accesses the treatment area from within the blood vessel. In the case of aneurysms, this treatment is called coil embolization, or "coiling". In contrast to surgery, endovascular coiling does not require open surgery. Instead, physicians use real-time X-ray technology, called fluoroscopic imaging, to visualize the patient's vascular system and treat the disease from inside the blood vessel.
Endovascular treatment of brain aneurysms involves insertion of a catheter (small plastic tube) into the femoral artery in the patient's leg and navigating it through the vascular system, into the head and into the aneurysm. Tiny platinum coils are threaded through the catheter and deployed into the aneurysm, blocking blood flow into the aneurysm and preventing rupture. The coils are made of platinum so that they can be visible via X-ray and be flexible enough to conform to the aneurysm shape. This endovascular coiling, or filling, of the aneurysm is called embolization and can be performed under general anesthesia or light sedation. More than 125,000 patients worldwide have been treated with detachable platinum coils.
Risks associated with Angiograms:
• Injury to normal blood vessels in the leg, abdomen, chest, neck, head, and brain. (estimated risk < 1%)
• Infarction of brain (stroke) or spinal cord. (estimated risk < 0.5%)
• Infarction of vital organs and other tissue. (estimated risk < 1%)
• Allergic reaction. (estimated risk < 1%)
• Infection. (estimated risk < 1%)
• Bleeding of blood vessels in the leg, abdomen, chest, neck, or head. (estimated risk < 1%)
• Blood clots. (estimated risk < 1%)
• Nerve damage. (estimated risk < 1%)
During your Angiogram:
You will be sedated and comfortable.
After cleansing and numbing your groin area, a small incision will be made and a catheter will be inserted into your femoral artery. The neurosurgeon will pass this catheter slowly through the arteries and vessels to the neck, by visualizing the path on a TV like monitor, where contrast dye will be injected. The contrast dye allows the blood vessels to be visible while x-ray pictures are being taken.
During the procedure a registered nurse will monitor your blood pressure, heart rate, and oxygen level. You may communicate to your doctor or nurse if you feel anxious or uncomfortable at anytime throughout the procedure and medication will be given to help you feel more comfortable.
When the contrast dye is being injected some patients report feeling a warm flushing sensation to their face or a salty taste in their mouth. These sensations are brief and a normal response to the contrast dye.
Will I be in pain?
The procedure is generally not painful. You are sedated so that you are still and comfortable, but you will be able to communicate with the surgeon if needed. You will receive a local anesthetic prior to the incision and insertion of the catheter. You may feel a burning sensation briefly. You may also experience a hot or flushed feeling when the dye is injected. Please do not hesitate to communicate any discomfort during the procedure.
What happens after the angiogram is completed?
When the study is completed, the catheter will be removed from your artery and pressure will be applied at the point of entry. If needed, the doctor may choose to close the artery puncture with a closure device. You then will be transported to the Day Care Unit for observation. You must stay in bed for the next 2 to 6 hours. Your doctor will determine how long you should stay in bed. If a closure device is used, the period that you lie flat is shorter.
During your stay, your vital signs will be monitored regularly. The registered nurse will also check the incision site and pedal pulses regularly. You will be instructed to keep your leg straight to prevent any bleeding from the incision site. You will be given IV fluids and will be encouraged to drink plenty of fluids. You will be able to eat a light snack.
You should not drive or operate heavy machinery 24 hours after the procedure.
You may shower the day after your angiogram. No baths or swimming until incision is completely healed (10-14 days).
You should NOT lift, push, pull, or strain your abdominal muscles for at least 7 days after your procedure. Do not lift anything heavier than 10 lbs. Do not engage in any strenuous activities. You may resume your normal activities 7 days after your procedure.
You may resume your normal medication regimen. Please talk to the doctor prior to restarting Coumadin, Lovenox, or Metformin.
It is normal to have some discomfort to the incision site after the angiogram. You may take Tylenol if appropriate. Some bruising at the incision site is normal.
A follow-up appointment with Dr. Thomas will be scheduled to review your results.
