Diagnostic cerebral angiography is a special test performed to provide a map of the blood vessels in the brain. Although it is an invasive procedure, cerebral angiography is considered the best way (=gold standard) to look at the blood vessels.
Here are some Q&A about the procedure:
- What makes cerebral angiography an invasive procedure?
- A port is first placed into the artery of the leg, in the groin area. Through this port, a catheter with a wire is used to travel through the arteries of the body up to the neck. From there, contrast dye is given through the catheter and the blood flow carries the contrast up into the brain, which then produces a map of the blood vessels in the brain that is seen using fluoroscopy (a form of Xray).
- A port is first placed into the artery of the leg, in the groin area. Through this port, a catheter with a wire is used to travel through the arteries of the body up to the neck. From there, contrast dye is given through the catheter and the blood flow carries the contrast up into the brain, which then produces a map of the blood vessels in the brain that is seen using fluoroscopy (a form of Xray).
- Does this procedure hurt?
- Believe it or not, the procedure is actually very well tolerated and performed awake with minimal sedation. Most patients report that the anxiety of not knowing what to expect is the worst part of the test. The only uncomfortable part of the procedure is in the beginning, when the port is placed into the leg artery. For this part, local anesthetic (=numbing medication) is used beforehand to minimize any pain. Some patients report that the port placement is actually better than having an IV placed in the hand!
- Once the port is in, the rest of the procedure is just a series of heat sensations (or hot flashes) that last a few seconds each time when the images of being taken.
- Believe it or not, the procedure is actually very well tolerated and performed awake with minimal sedation. Most patients report that the anxiety of not knowing what to expect is the worst part of the test. The only uncomfortable part of the procedure is in the beginning, when the port is placed into the leg artery. For this part, local anesthetic (=numbing medication) is used beforehand to minimize any pain. Some patients report that the port placement is actually better than having an IV placed in the hand!
- How long does the procedure take? Will I need to stay in the hospital overnight?
- The actual procedure can take about 20-30 minutes to complete, however there is preparation time before and recovery time after. The recovery time usually is 2-4 hours of laying flat, keeping the legs straight. After the recovery period, you will be able to go home — no need to stay in the hospital overnight.
- The actual procedure can take about 20-30 minutes to complete, however there is preparation time before and recovery time after. The recovery time usually is 2-4 hours of laying flat, keeping the legs straight. After the recovery period, you will be able to go home — no need to stay in the hospital overnight.
- What are the risks of the procedure?
- The most common thing that can happen is a hematoma (=bruise) in the groin area where the port was placed. This happens because when we place the port, a hole in made in the femoral artery in the leg. When we remove the port, this hole has to heal by forming a scab — in this process, some blood can ooze out and form a bruise. If a hematoma does form, it will go away on its own in a few weeks.
- Other risks that are rare are allergic reactions to medications or the contrast dye, temporary kidney damage in patients with poor kidney function or diabetes, infection.
- The most serious thing that can happen is a stroke. The percentage risk of this happening depends on the patient’s age and the experience of the person performing the procedure. On average, this happens less than 1%.
- Are there any alternatives to this procedure?
- Yes, there are alternative tests that are non-invasive. These are CT angiography or MR angiography. However, the quality and information gathered from these alternatives are not as good as, especially for detecting small abnormalities. Here’s an example comparison of the resolution and information obtained: MR and CT angiography are like black and white TV versus diagnostic cerebral angiography are like color TV.
- Yes, there are alternative tests that are non-invasive. These are CT angiography or MR angiography. However, the quality and information gathered from these alternatives are not as good as, especially for detecting small abnormalities. Here’s an example comparison of the resolution and information obtained: MR and CT angiography are like black and white TV versus diagnostic cerebral angiography are like color TV.
Dr. Li-Mei Lin 