brain and brain vessels arteriogram: uses, function and aftercare

Cerebral angiography is a diagnostic test that uses an X-ray. It produces a cerebral angiogram, or an image that can help your doctor find blockages or other abnormalities in the blood vessels of your head and neck. Blockages or abnormalities can lead to a stroke or bleeding in the brain. For this test, a doctor injects a contrast medium into your blood. The contrast material helps the X-ray create a clear picture of your blood vessels so that your doctor can identify any blockages or abnormalities.

why is brain arteriogram done?

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:

• Aneurysm: Ballooning or bulging of a blood vessel
• Stenosis: Blood vessel narrowing
• Atherosclerosis: Narrowing of the arteries
• Vasculitis: Inflammation of the blood vessels that narrows them
• arteriovenous malformation: Abnormal connection between the arteries and veins
• thrombosis: A blood clot within a blood vessel
• vasospasm: A spasm of the blood vessel causing an irregular narrowing of the vessel
• 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 or edema
• Dislocation of the brain tissue, caused by pressure within the brain due to swelling, bleeding, or other reasons herniation
• A tear in an artery
• Increased pressure within the brain
• Fluid in the brain or hydrocephalus

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

how to prepare for brain arteriogram

• Your doctor 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.
• Be sure to tell your doctor if you have ever had a reaction to any contrast dye, or if you are allergic to iodine or shellfish.
• Tell your doctor if you are sensitive to or are allergic to any medicines, latex, tape, and anesthetic agents (local and general).
• You will need to fast (not eat) for a certain time prior to the procedure. Your doctor will tell you how long to fast, whether for a few hours or overnight.
• Tell your doctor if you are pregnant or think you may be.
• Make sure your doctor has a list of all medicines (prescribed and over-the-counter) and all herbs, vitamins, and supplements that you are taking.
• You may be given a medicine to relax you and make you sleepy before the procedure. You may also receive an anticholinergic medicine, which slows down the production of saliva in the mouth, blocks the production of acid in the stomach, and slows down the activities of the intestinal tract, among other effects. If you get this medicine, you may notice that your mouth feels dry.
• Tell your doctor if you 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.
• Depending on the site used for injection of the contrast dye, the recovery period may last up to 12 to 24 hours. You should be ready to spend the night if necessary.
• Your doctor may request a blood test prior to the procedure to see how long it takes your blood to clot. Other blood tests may be done as well.
• Based on your medical condition, your doctor may give you other instructions on what to do before the procedure.

operation

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 doctor's practices. Generally, a cerebral arteriogram follows this process:

• You will be asked to remove any clothing, jewelry, hairpins, dentures, or other objects that may get in the way of the procedure.
• If you are asked to remove clothing, you will be given a gown to wear.
• You will be reminded to empty your bladder before starting the procedure, which can take up to 3 hours.
• You will be positioned on the X-ray table.
• You may 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.
• The catheter (a thin, soft tube) will be put into an artery in either your neck, arm, or groin after the skin is cleansed and a local anesthetic (numbing medicine) is injected.
• If the catheter will be put into an artery in your groin or the arm, the doctor 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. If the arm is used, a blood pressure cuff will be applied to your arm below the insertion site and inflated to prevent flow of the contrast dye into your lower arm.
• Once the catheter is put into the artery at the groin or arm, it’s threaded through to an artery in the neck. A special type of X-ray, called fluoroscopy, may be used to verify the location of the catheter inside your body.
• 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 doctor 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 and/or vomiting. These effects usually only last for a few moments.
• You should tell the doctor right away if you have any breathing difficulties, sweating, numbness, or heart palpitations.
• 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.
• Depending on the study being done, there may be one or more injections of contrast dye.
• When the test is done, the catheter will be removed and pressure will be applied over the area to keep the artery from bleeding.
• 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.

after cerebral arteriogram

Depending on which site was used for injection of the contrast dye, you will stay flat in bed in a recovery room 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. If the neck was used, you will be watched for signs of hoarseness, breathing problems, or pain or difficulty in swallowing.

• A nurse will monitor your vital signs, your neurological signs, and the injection site while you are in the recovery room.
• 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 and activities after the procedure, unless your doctor tells you otherwise.
• 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.

aftercare of brain arteriogram at home

• 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, you should 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.

Risks and complications

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
• Paralysis on one side of the body
• Blood clot in the blood vessel
• Bleeding
• A collection of blood and swelling
• Stroke
• Loss of the ability to speak or understand speech