Cerebral and Spinal Angiography

Overview

Cerebral and spinal angiography use a catheter, x-ray imaging guidance and an injection of contrast material to examine blood vessels in the brain or spine for abnormalities such as aneurysms and AVMS, and disease such as atherosclerosis (plaque). 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 painlessly guided through the body to various vessels in the neck or spine that supply blood to the brain or spine. Once there, contrast material is injected through the tube and images are captured using ionizing radiation (x-rays). Angiography produces very detailed, clear and accurate pictures of blood vessels in the brain.

Preparation

Your doctor will instruct you on how to prepare, including any changes to your medication schedule. Tell your doctor if there's a possibility you are pregnant and discuss any recent illnesses, medical conditions, medications you're taking, and allergies, especially to iodinated contrast materials. If you're breastfeeding, ask your doctor how to proceed. If you are to be sedated, you may be told not to eat or drink anything for eight hours before your procedure. Also, you should plan to have someone drive you home. Leave jewelry at home and wear loose, comfortable clothing. You will be asked to wear a gown.

A cerebral angiogram may be performed:

  • to evaluate arteries of the head and neck before surgery.

  • to provide additional information on abnormalities seen on MRI or CT of the head, such as the blood supply to a tumor.

  • to prepare for other medical treatment, such as in the surgical removal of a tumor.

  • in preparation for minimally invasive treatment of a vessel abnormality.

The procedure may also be used to help diagnose the cause of symptoms, such as:

  • severe headaches

  • slurred speech

  • dizziness

  • blurred or double vision

  • weakness or numbness

  • loss of coordination or balance.

How is the procedure performed?

This procedure is typically done on an outpatient basis. Prior to your procedure, your blood may be tested to determine how well your kidneys are functioning and whether your blood clots normally. Because the cerebral angiogram and recovery period may last for several hours, you will be asked to empty your bladder before the procedure begins.

As part of prep for the procedure a nurse will insert an IV line into a vein in the hand or arm which will be used to draw blood and administer sedation. Two drugs, midazolam and Fentanyl are administered during the procedure for moderate sedation. The patients is then moved to the angiography table and the area where the catheter is inserted is sterilized and covered with a surgical drape. Patients heads are often taped down in order to minimize movement to obtain the clearest possible pictures during the exam.

The procedure is not painful, although there will be stinging and burning as the catheter insertion site is numbed up with medication. Patients may feel a lot of pressure as the catheter sheath is then inserted into the body. Once the sheath is in place there should not be any further pain or discomfort. With moderate sedation, most patients report feeling relaxed, sleepy and comfortable for the procedure. You may or may not fall asleep, but should not experience pain as pictures are being acquired.

The procedure is usually completed within one hour and when finished the catheter will be removed and a dissolvable vascular closure device will typically be used to plug the puncture site. This is then covered with a small dressing or bandage. Patients are then asked to lie semi flat for two hours after which they are able to go home. During the two hour recovery period, Dr. Geraghty will stop by to discuss the results of the tests with you and your family members. The procedure is very safe with less than 1/1000 risk of stroke or other serious complication such as damage to kidneys or allergic reaction. The most common risks are bruising or bleeding at the catheter insertion site, although this is also relatively uncommon.