A Patient's Guide to Cerebral Angiography

What is 'Cerebral Angiography' or a 'Brain Cath'?

It is a procedure which uses a dye (contrast material) and X-rays to visualize the arteries and veins in the neck and brain.

When is it performed?

This test is generally recommended by the doctor to evaluate patients with stroke, brain bleed, aneurysms,vascular malformations and brain tumors.

Who performs the procedure?

A specialist trained in neurointerventions can perform angiography. The specialist may be a neurosurgeon, neuro-radiologist or a neurologist.

How do I prepare for an angiogram?

Before scheduling the procedure, your doctor will check your kidney function and order other blood tests. Please inform your doctor about

1. Your allergies (specifically allergy to shellfish and iodine)
2. History of bleeding gums or easy bruising in the past
3. Your medications (specifically Metformin for diabetes mellitus)
4. Whether you are pregnant
5. You may be asked to not eat and drink anything for about 8-12 hours prior to the procedure

How is the procedure performed?

1. You will be asked to lie on a X-ray table.
2. Your head may be strapped using a tape to keep it still.
3. You may be given intravenous medications for pain and to put you to light sleep.
4. A numbing medication (local anesthesia) is given around the artery in the groin (femoral artery). You may have a transient stinging or burning sensation when the medication is injected in the groin.
5. A long catheter (a catheter is a long slender tube) is inserted through the artery in the groin and passed all the way up to the neck with the help of X-rays
6. Contrast dye is injected into the various arteries in the neck that carry blood to the brain and X-ray pictures taken to visualize the arteries and the veins and the blood flow pattern.
7. A diagnostic angiogram usually lasts about 30-45 minutes depending upon the specific arteries and veins that are being examined.
8. While the dye is being injected, you may feel a warm flushing sensation. You may also experience a metallic taste in the mouth for a few minutes.
9. After the angiogram, the doctor removes the tube from the groin and holds pressure over the artery in the groin to allow blood to clot and seal the hole in the artery.
10. Alternatively, your doctor may use a closure device to seal the hole in the artery.

How long do I have to stay in the hospital after the procedure?

A diagnostic cerebral angiogram is usually performed as an outpatient procedure. You will have to lay flat in the bed for about 3-6 hours after which you may be discharged home.

What precautions should I take after going home?

1. It is recommended not to drive or do any strenuous work for 1-2 days after the procedure. 
2. Do not exercise. 
3. You may walk around in the house. 
4. You may have some soreness in the groin for a couple of days. 
5. You may resume normal daily activity from the next day or the day after. 
6. You may take over-the-counter pain medications, if needed. 
7. If you are diabetic and take Metformin, do not take the medication for 24-48 hours following the procedure.
8. Immediately call the doctor's office if you experience

• severe itching all over the body
• rash over the groin or anywhere in the body
• swelling in the groin
• bleeding from the groin
• slurred speech
• weakness of an arm or leg

What are the risks of Cerebral Angiography?

1. There is a small risk of allergy to the contrast dye. If you have a history of allergy to the dye, your doctor may ask you to take some medications prior to the procedure to prevent any allergic reaction
2. There is a small risk of bleeding from the puncture site in the groin (1%-2%). Alternatively the bleeding may be under the skin forming a 'pseudo-aneurysm'. A swelling may be seen in the puncture site in the groin.
3. In about 0.5%-1% of the patients, a clot from within the catheter or a cholesterol plaque from one of the arteries in the neck may be dislodged and block an artery supplying the brain leading to stroke. With the advent of newer techniques, the incidence of a major or significant stroke following diagnostic angiography in experienced hands is very low.