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Cerebral Arteriogram
TESTS AND PROCEDURES

Cerebral Arteriogram

May 07, 2019

An arteriogram is an X-ray of the blood vessels. When done in the brain, it's called cerebral arteriogram or cerebral angiogram. It’s used to look for changes in the blood vessels, such as:

  • Ballooning of a blood vessel (aneurysm)
  • Narrowing of a blood vessel (stenosis)
  • Blockages

For an arteriogram, your healthcare provider inserts a catheter into a large blood vessel and injects contrast dye. The contrast dye causes the blood vessels to appear on the X-ray image. This lets the healthcare provider better see the vessel(s) under exam.

For a cerebral arteriogram, a catheter is usually inserted into an artery in the groin. Sometimes, a large artery in the arm is used. Rarely, an artery in the neck may need to be used. The groin artery is most commonly used because it’s easier to get to. Once the catheter is inserted, the contrast dye is injected. Next, a series of X-rays are made. These images show the arteries, veins, and capillaries and blood flow in the brain.

This test may be advised when previous tests don’t give enough information. 

A cerebral arteriogram is used to look for changes in the blood vessels within or leading to the brain. Such as:

  • Ballooning or bulging of a blood vessel (aneurysm)
  • Blood vessel narrowing (stenosis)
  • Narrowing of the arteries (atherosclerosis)
  • Inflammation of the blood vessels that narrows them (vasculitis)
  • Abnormal connection between the arteries and veins (arteriovenous malformation)
  • A blood clot within a blood vessel (thrombosis)
  • A spasm of the blood vessel causing an irregular narrowing of the vessel (vasospasm)
  • Complete blockage of a blood vessel

Conditions that cause a displacement of the brain's blood vessels may also be seen. These conditions include:

  • Tumors
  • Stroke
  • Swelling (edema)
  • Dislocation of the brain tissue, caused by pressure within the brain due to swelling, bleeding, or other reasons (herniation)
  • A tear in the wall of an artery
  • Increased pressure within the brain
  • Fluid in the brain (hydrocephalus)

A cerebral arteriogram may be used to locate or assess clips on blood vessels placed during previous surgical procedures.

Your healthcare provider may have other reasons to recommend a cerebral arteriogram. Talk with your healthcare provider about the reason for your test.

You may want to ask your healthcare provider about the how much radiation is used during the procedure and the risks related to your situation. It’s a good idea to keep a record of your history of radiation exposure, such as previous CT scans and other types of X-rays, so that you can tell your healthcare provider. Risks linked to radiation exposure may be related to the number of X-rays or treatments over a long period.

Tell your healthcare provider if you are pregnant or think you may be. Radiation exposure during pregnancy may lead to birth defects. If you need to have a cerebral arteriogram, special precautions will be taken to reduce the radiation exposure to the fetus.

There is a risk for an allergic reaction to the dye used for this test. Tell your provider if you are allergic to or sensitive to medicines, contrast dye, shellfish, or iodine. Also tell your provider if you have kidney failure or other kidney problems.

Tell your healthcare provider if you have a history of bleeding disorders or if you are taking blood-thinning medicines (anticoagulatns), aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before the procedure.

Because the procedure involves the blood vessels and blood flow of the brain, there is a small risk for complications involving the brain. These complications may include:

  • Loss of consciousness
  • Transient ischemic attack (TIA)
  • Paralysis on one side of the body (hemiplegia)
  • Blood clot in the blood vessel (embolus)
  • Bleeding or bruising at the puncture site
  • Infection
  • A collection of blood and swelling (hematoma) at the site where the catheter is put in
  • Stroke
  • Loss of the ability to speak or understand speech (aphasia)

There may be other risks depending on your specific health condition. Discuss any concerns with your healthcare provider before the procedure.

  • Your healthcare provider will explain the procedure to you and ask if you have questions.
  • You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if anything is not clear.
  • Tell your healthcare provider, the radiologist, or the technologist if you:
    • Have ever had a reaction to any contrast dye, or if you are allergic to iodine or shellfish.
    • Are sensitive to or are allergic to any medicines, latex, tape, and anesthetic agents (local and general).
    • Are pregnant or think you may be.
    • Have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before the procedure.
  • Follow any directions you are given for not eating or drinking before the procedure.
  • Give your healthcare provider a list of all prescribed and over-the-counter medicines and all herbs, vitamins, and supplements you are taking.
  • You may be given a medicine to relax you and make you sleepy before the procedure. If you will be going home after the procedure, have someone with you to drive you home.
  • You may also get anticholinergic medicine. This slows down how much saliva you make. It also blocks the production of acid in the stomach, and slows down the activities of the digestive tract. If you get this medicine, you may notice that your mouth feels dry.
  • Depending on the site used for injection of the contrast dye, the recovery period may last up to 12 hours. You may need to spend the night in the hospital, if necessary.
  • Your healthcare provider may request a blood test before the procedure to see how long it takes your blood to clot. Other blood tests may be done as well.
  • Your healthcare provider may give you other instructions on what to do before the procedure.

A cerebral arteriogram may be done on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your healthcare provider's practices.

Generally, a cerebral arteriogram follows this process:

  1. You will be asked to remove any clothing, jewelry, hairpins, dentures, or other objects that may get in the way of the procedure.
  2. If you are asked to remove clothing, you will be given a gown to wear.
  3. You will be reminded to empty your bladder before starting the procedure, which can take up to 3 hours.
  4. You will be positioned on the X-ray table.
  5. You will be connected to an electrocardiogram (ECG) monitor that records the electrical activity of your heart. Your vital signs (heart rate, blood pressure, and breathing rate) and neurological signs will be watched during the procedure. You will have an IV (intravenous) line put in to give you the sedative medicine.
  6. The catheter (a thin, soft tube) will be put into an artery in either your neck, arm, or groin after the skin is cleansed, a local anesthetic (numbing medicine) is injected, and a small cut (incision) is made.
  7. If the catheter will be put into an artery in your groin or the arm, the radiologist will check your pulses below the site and mark them with a marker so that the circulation to the limb below the site can be checked after the procedure. In some cases, the catheter is put into an artery in your neck. If the neck is used, a pillow will be placed under your shoulders to keep your neck extended. Your head will be held in place with a strap or tape to prevent the risk of damage to the artery that might happen if you move your head. If the groin or arm is used, the site will be shaved prior to insertion of the catheter.
  8. Once the catheter is put into the artery , it’s threaded through to an artery in the neck. A special type of X-ray, called fluoroscopy, will be used to verify the location of the catheter inside your body.
  9. An injection of contrast dye will be given. The contrast dye makes the blood vessels show up on the X-ray image. This allows the healthcare provider to better see the structure of the vessel(s).You may feel some effects when the dye is injected into the catheter. These effects include a flushing sensation, a salty or metallic taste in your mouth, a brief headache, or nausea or vomiting. These effects usually only last for a few moments.
  10. You should tell the radiologist right away if you have any breathing difficulties, sweating, numbness, or heart palpitations.
  11. After the contrast dye is injected, a series of X-rays will be taken. The first series of X-rays shows the arteries, and the second series shows capillary and vein blood flow.
  12. Depending on the study being done, there may be one or more injections of contrast dye.
  13. When the test is done, the catheter will be removed and pressure will be applied over the area or a plug-like device will be used to keep the artery from bleeding.
  14. After the site stops bleeding, a dressing will be applied to the site. A sandbag or other heavy item may be placed over the site to prevent further bleeding or the formation of a hematoma at the site.

Depending on which site was used for injection of the contrast dye, you may need to stay flat in bed in a recovery area for several hours after the procedure. If the groin or arm site was used, the leg or arm on that side will be kept straight for up to 12 hours. The healthcare staff may use ice to ease pain and swelling. If the neck was used, you will be watched for signs of hoarseness, breathing problems, or pain or trouble swallowing.

A nurse will monitor your vital signs, your neurological signs, and the injection site while you are in the recovery area.

You may be given pain medicine for pain or discomfort related to the injection site or pain from having to lie flat and still for a long period.

You will be encouraged to drink water and other fluids to help flush the contrast dye from your body.

You may go back to your usual diet after the procedure, unless your healthcare provider tells you otherwise. You may go back to your usual activities about 8 to 12 hours after the procedure.

When you have completed the recovery period, you may be returned to your hospital room or discharged to your home. If this procedure was done as an outpatient, plan to have another person drive you home.

Home care

Once home, check the injection site for bleeding. A small bruise is normal, as is an occasional drop of blood at the site.

If the groin or arm was used, monitor the leg or arm for changes in temperature or color, pain, numbness, tingling, or loss of function of the limb.

Drink plenty of fluids to prevent dehydration and to help flush out the contrast dye.

You may be advised not to do any strenuous activities or take a hot bath or shower for a period after the procedure.

When should I call my healthcare provider?

Get prompt medical attention if any of the following happen:

  • Fever or chills
  • Increased pain, redness, swelling, bleeding, or other drainage from the injection site
  • Coolness, numbness and/or tingling or other changes in the affected extremity
  • Speech or vision changes
  • Dizziness
  • Muscle weakness or numbness
  • Chest pain
  • Trouble breathing

Your healthcare provider may give you other instructions after the procedure, depending on your situation.

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how you will get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much you will have to pay for the test or procedure

Updated:  

May 07, 2019

Sources:  

Evaluation of carotid artery stenosis. UpToDate

Reviewed By:  

Raymond Kent Turley BSN MSN RN ,Kenny Turley PA-C,Maryann Foley RN BSN