For many years, the brain was perceived as a complex and mysterious organ. Much like the unexplored areas of our galactic universe, neurosurgical professionals knew there were answers to their most pressing questions—but had few opportunities to achieve clarity. Today is quite a different story.
In diagnosing and treating brain-related disorders, medical professionals are now equipped with an array of tests. Some of the most commonly known include MRI, CT, and EEG. Lesser known are myelogram, nerve conduction velocity, and neurosonography. Among all options, the cerebral angiogram stands out as a powerful procedure that has been saving lives for decades. The following information will give you all the basic details surrounding a cerebral angiogram—including why it is used, who might need to undergo this procedure, what happens during and after the angiogram, and what it is like to go through this procedure.
What Is a Cerebral Angiogram?
The cerebral angiogram is a procedure and a diagnostic test that involves the use of x-ray imaging to view the blood vessels in the brain. By injecting a contrast dye into the blood vessels and capturing x-ray images, neurosurgeons can gain invaluable insights into the brain’s entire vascular system. This information is critical in diagnosing various disorders and planning surgeries or other treatments.
In comparison to other diagnostic procedures, cerebral angiogram is more accurate than CT angiography (CTA) or MR angiography (MRA) in assessing the presence of or anatomy of vascular lesions.
Is a Cerebral Angiogram Considered Surgery?
One common query we receive regarding this procedure is, “Is a cerebral angiogram considered surgery?” Technically, it’s not. A cerebral angiogram is a minimally invasive diagnostic procedure. Though it involves puncturing the skin to insert a catheter, it is generally less complex and carries fewer risks than open surgery.
Over the years, medical science advancements have progressed procedures such as this to be more patient-first. Meaning, less downtime, better results, and improved outcomes.
A Detailed View of the Cerebral Angiogram Procedure
For anyone considering this procedure, understanding what it entails is crucial. Initially, the patient is sedated and the skin near the artery of the leg or wrist is numbed with medication. Then, a thin tube called a catheter is inserted through a small incision into the blood vessel. This is most often done in the groin, less commonly the wrist. This catheter is then carefully guided through the blood vessels until it reaches the neck or head. The contrast dye is subsequently injected, and high resolution x-ray images are taken. The following represents a step-by-step guide of these processes.
Watch this video of a Cerebral Angiogram procedure:
Preparation
Before the procedure, the patient will typically undergo a physical examination, and the doctor will review their medical history. The patient might be asked to fast for a certain period before the angiogram. They will also be advised on which medications to take or avoid before the procedure. Once in the hospital, the patient will change into a hospital gown and an IV line will be placed in their arm. The angiogram is performed in a cath lab, with specialized x-ray and monitoring equipment.
Sedation and Local Anesthesia
The patient is usually awake during a cerebral angiogram but will be given sedatives to help them relax. We often describe this as “twilight sleep”. Local anesthesia is applied to numb the area where the catheter will be inserted, typically in the groin or sometimes the wrist.
Catheter Insertion
The physician makes a small incision in the groin area and inserts a thin, flexible tube called a catheter into the artery. The catheter is then threaded through the arterial system towards the blood vessels of the brain. Fluoroscopy, a real-time x-ray imaging technique, is used to guide the catheter to the correct position.
Contrast Injection and Imaging
Once the catheter is in place, contrast dye is injected from the catheter into the blood vessels. This dye highlights the blood vessels on high-resolution x-ray images. The physician takes a series of x-ray images from multiple different angles, capturing the dye as it moves through the brain’s arteries. This provides a detailed view of the blood vessels and highlights any abnormalities. Often we are able to generate a full 3-D picture of the blood vessels of the brain that can be used for modeling and surgical planning.
Catheter Removal and Wound Dressing
After the images are taken, the catheter is carefully withdrawn. The incision site is then compressed to minimize bleeding, and a dressing is applied. In some cases, a small closure device may be used to seal the artery.
Recovery Room
The patient is moved to a recovery room and will need to lie flat for several hours to prevent bleeding from the catheter insertion site. During this time, the medical staff monitors vital signs and the insertion site for any complications. After the =sedation has worn off, the patient is able to eat, relax and be accompanied by a loved one.
Post-Procedure Instructions and Follow-Up
Before leaving the hospital, the patient will receive instructions on how to care for the wound and when to resume normal activities. A follow-up appointment is usually scheduled to discuss the results of the angiogram with the physician.
It’s important to remember that while cerebral angiogram is a common procedure, it requires experienced neurosurgical professionals to ensure it’s performed safely and effectively. The patient should communicate openly with their healthcare team and follow all pre- and post-procedure instructions carefully. At New Jersey Brain and Spine, we encourage all our patients to ask us any questions so we can address their concerns.
How Long Does a Cerebral Angiogram Take?
The length of a cerebral angiogram varies depending on the complexity of the case. Generally, the procedure takes around 30-60 minutes. Including preparation and recovery time, patients can expect to be in the hospital for about six to eight hours before going home..
Cerebral Angiogram Recovery
After the procedure, patients usually need to lie flat for a few hours to prevent bleeding from the catheter insertion site. Most patients can leave the hospital on the same day, but it is important to take it easy for a few days. Full recovery is usually swift, with most individuals resuming normal activities within a week.
What Can be Diagnosed with a Cerebral Angiogram?
A diagnostic cerebral angiogram can identify a host of conditions. Some life-threatening issues that can be diagnosed include the following.
Aneurysms
Aneurysms are bulges that occur in the walls of blood vessels. When an aneurysm is present in the brain, it’s known as a cerebral aneurysm. This condition is particularly dangerous because as the blood vessel wall stretches, it becomes thinner and can rupture.
If a cerebral aneurysm ruptures, it leads to a subarachnoid hemorrhage, which is bleeding into the space between the brain and the surrounding membrane. This can cause severe headaches, nausea, vomiting, and even death. Through a cerebral angiogram, doctors can see the size and shape of the aneurysm and make decisions about the best treatment options, such as surgical clipping, endovascular coiling or flow diversion.
Arteriovenous malformations (AVMs)
Arteriovenous malformations (AVMs) are abnormal tangles of blood vessels in the brain or spine. They are typically characterized by arteries connecting directly to veins without a capillary network, which disrupts normal blood flow. Because of this abnormal blood flow, the walls of the blood vessels in an AVM can become weak and may rupture, causing bleeding in the brain (hemorrhage).
Symptoms include headaches, seizures, and neurological problems. A cerebral angiogram helps in identifying the location and characteristics of AVMs, which is essential for planning surgical or endovascular interventions.
Stroke
A stroke occurs when the blood supply to part of the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. There are two main types of stroke: ischemic (caused by blocked arteries) and hemorrhagic (caused by bleeding in the brain). In both cases, it is crucial to restore blood flow quickly. A cerebral angiogram can identify the exact location of blockages or hemorrhages, and sometimes the procedure can be extended to include treatment—such as removing a clot or repairing a blood vessel.
Stenosis
Stenosis refers to the narrowing of blood vessels. When it occurs in the brain, it can reduce blood flow, potentially leading to a stroke. This is often caused by the buildup of plaque, a condition known as atherosclerosis.
Symptoms may include weakness, difficulty speaking, or loss of coordination. Through a cerebral angiogram, doctors can observe the narrowed blood vessels and determine the severity of stenosis, which helps in choosing the right treatment strategy, such as medication, angioplasty, or stenting.
Tumors
A cerebral angiogram is also an effective tool for analyzing tumors within the brain. By observing the blood vessels that feed tumors, doctors can determine the size and location of the tumor and how aggressively it’s growing. This information is indispensable for planning surgeries or other treatments like radiation therapy.
By expanding our understanding of these conditions, it’s evident that cerebral angiogram is not just a diagnostic tool but an essential procedure that guides the treatment pathway in several life-threatening conditions within the brain.
The Role of Cerebral Angiogram in Treatment
Beyond diagnosis, cerebral angiograms play a pivotal role in the treatment of brain conditions. This test allows for precise visualization of the blood vessels, which is crucial for surgical planning and treatment selection. In some cases, doctors can even perform therapeutic procedures during the angiogram, such as sealing an aneurysm or opening a narrowed blood vessel.
Are There Any Risks Associated with Cerebral Angiogram?
While cerebral angiogram is an advanced diagnostic tool, like any medical procedure it comes with its set of risks and potential complications. The general risk of a cerebral angiogram is very low, around 1%. The following are some of the possible complications, while very rare, that could occur.
- Allergic Reaction to Contrast Dye: Some patients may experience an allergic reaction to the contrast dye used in the procedure. This can range from mild itching or rash to severe anaphylactic reactions in rare cases.
- Infection: As the procedure involves inserting a catheter through the skin, there is a risk of infection at the insertion site. Proper sterile techniques can minimize this risk.
- Bleeding: There’s a risk of bleeding at the site where the catheter is inserted. In rare cases, internal bleeding may occur if a blood vessel is damaged during the procedure.
- Blood Clots: The catheter’s movement through blood vessels could cause a clot to form or dislodge, which can lead to a stroke or other complications.
- Kidney Damage: The contrast dye used during the angiogram can, in some cases, cause kidney damage, particularly in patients with pre-existing kidney conditions.
- Radiation Exposure: As the procedure uses x-rays, there is exposure to radiation, though it’s generally considered to be at safe levels.
- Damage to Blood Vessels: Rarely, the catheter can damage the blood vessels as it’s guided through them. This can lead to additional complications, such as stroke or bleeding.
- Arrhythmias: Sometimes, the procedure can temporarily affect the heart’s rhythm, causing arrhythmias. These are usually temporary but can be concerning for patients with heart conditions.
- Neurological Complications: Although rare, there is a risk of temporary or permanent neurological complications such as weakness, numbness, or difficulty speaking if a blood vessel in the brain is damaged during the procedure.
The benefits of obtaining critical information about brain conditions often outweigh these risks—particularly when the procedure is performed by experienced medical professionals. Additionally, appropriate pre-procedure assessments and patient preparation are vital in minimizing these risks.
For example, some individuals will need to cease taking certain medications that may increase bleeding risk. Consult with your neurosurgeon with any questions you may have prior to the procedure.
Cerebral Angiogram: An Invaluable Neurosurgical Tool
A cerebral angiogram is an invaluable tool in the arsenal of modern medicine. With its ability to offer detailed images of the brain’s vasculature, it paves the way for accurate diagnoses and effective treatment of life-threatening conditions. Though it carries a low risk, the cerebral angiogram is a generally safe and critically important procedure for those facing potential brain disorders. By demystifying its aspects, we can better appreciate the profound impact that this diagnostic tool has on countless lives.
New Jersey Brain and Spine has the most experienced and sophisticated neurovascular program in the region. Our experts have deep and vast knowledge in performing cerebral angiograms and we have the most up-to-date technology available.
If you or a loved one is concerned about a brain-related issue, please don’t wait to address it. There are many solutions we can implement to avoid the worst-case scenario. Connect with our physicians to learn more.
