Have you ever wondered how to find out if there is something wrong with the delicate blood vessels inside your head, that is, the brain? Sometimes, a sudden headache, difficulty speaking, or loss of sensation in an arm or leg can be caused by a problem with the blood vessels in your brain. In such cases, doctors may suggest that you undergo a special test called a cerebral angiogram. So, let's talk about this in detail, very simply.
So, what is a cerebral angiogram?
Simply put, a cerebral angiogram is a special diagnostic procedure that examines the condition of the blood vessels in your brain. It is performed by healthcare providers who have received special training in this area, usually in a hospital operating room.
This is what happens in this test:
1. A doctor inserts a thin plastic tube called a catheter into a large artery in your wrist or groin.
2. Then, a contrast material or a special dye is injected through the catheter. This dye makes the shape of the blood vessels clearly visible.
3. Next, while you lie on the examination table, the doctor will take several X-ray pictures of your blood vessels.
This cerebral angiogram test produces much clearer, more detailed images of the blood vessels in the brain than other imaging methods, such as CT scans (computed tomography) or MRI scans (magnetic resonance imaging) . It is also called digital subtraction angiography of the brain (DSA) .
Why do I need this kind of test?
Sometimes a cerebral angiogram is done just to diagnose a condition, but other times, it can also help doctors treat certain conditions.
There are several reasons why doctors use this test. One is to detect or confirm abnormalities in the blood vessels in your brain. Such conditions include:
- Brain aneurysm: This is when a blood vessel in the brain weakens and bulges like a balloon.
- Atherosclerosis: Fat deposits inside the arteries, causing them to become narrow or stiff.
- Arteriovenous Malformation: An abnormal connection between an artery and a vein.
- Dural Arteriovenous Fistula: Abnormal connection between arteries and veins in the membranes covering the brain.
- Vasculitis: Inflammation of the blood vessels, which means a swelling-like condition.
- Vascular Dissection: Tearing of the inner wall of an artery.
- Stroke: This can be caused by a blood clot blocking a blood vessel that supplies blood to the brain.
There are other uses:
- Before undergoing surgery or other medical treatment on your head or neck, check the condition of the arteries there.
- Find out how a brain tumor is supplied with blood and from which blood vessels.
- Learn more about abnormalities seen on other scans (MRI, CT).
How should I prepare for this test?
Before a cerebral angiogram, your doctor will make sure it's safe for you to have this test. They'll do a physical exam, order some blood tests, and ask about your medical conditions and any medications you've taken.
You should definitely tell your doctor these things:
- About all the medications you are currently taking, including vitamins, supplements, and even over-the-counter medications (OTC).
- About any other medical conditions you have or any recent illnesses.
- Do you have any problems with blood clotting or are you taking any blood-thinning medications (e.g. aspirin). This includes painkillers called NSAIDs (nonsteroidal anti-inflammatory drugs) .
- Do you have any allergies , especially to anesthesia, contrast dye, or anything containing iodine?
- Are you pregnant or could you be pregnant?
If you are given a sedative (a medicine that makes you sleepy) to keep you calm during the test, your doctor will tell you not to eat or drink anything for four to eight hours before the test. Also, if you are given a sedative or general anesthesia, someone will need to be there to take you home after the test.
However, your doctor will give you specific instructions on how to prepare for the test, and any changes you may need to make to your usual medication or meal times. It is important to follow them exactly.
What happens during the test?
Typically, when a cerebral angiogram is performed, the following can be expected:
1. You will have to wear a special gown provided by the hospital.
2. A nurse or radiologic technologist will put an IV line in a vein in your arm. This is where a sedative will be given if needed. This will feel like a small needle being inserted. Some people, especially children and young adults, may also be given general anesthesia .
3. A nurse or someone else will attach devices to your body to monitor your heart rate and blood pressure throughout the test.
4. You will be made to lie down on the examination table.
5. Your head will be secured with a strap, tape, or a foam holder to prevent it from moving.
6. The doctor will clean the area where the catheter is inserted – usually your groin, leg, or arm – with an antiseptic solution.
7. Then, a local anesthetic is injected into the area to numb it. You may feel a slight burning sensation when it is injected, but the area will go numb after a while.
8. The doctor will make a very small cut in the skin where the catheter will be inserted.
9. While watching the imaging equipment, the catheter is inserted into the artery through a small hole made with a needle. You may feel a slight push at this point, but it should not hurt.
10. The catheter is then passed up the artery in your body until it reaches an artery in your neck. But you won't feel the catheter going through it.
11. Next, the doctor injects contrast material through the catheter. You may feel a slight stinging sensation as it goes into your body, but it will quickly disappear.
12. When the contrast medium reaches the blood vessels that the doctor wants to examine, he will take several X-ray pictures. During this time, you will be asked to remain still and may even be asked to hold your breath. This is how you can get good, clear pictures.
13. After taking the required number of images, the doctor removes the catheter.
14. The artery where the catheter was inserted is clamped for a while to prevent blood from accumulating in the surrounding tissues (hematomas). A closure device may also be used to close the small hole in the artery.
15. A nurse covers that small wound with a plaster.
16. Your IV line will also be removed.
How long will this take?
A cerebral angiogram usually takes about one to three hours to perform. However, additional time may be needed to prepare for the test and recover after the test.
How long will it take to recover after the test?
After the cerebral angiogram, you will be kept in a recovery room for observation for a while. You will usually be able to go home after a few hours.
Your doctor will give you specific instructions about what to do during your recovery, and you should follow them exactly.
- Once the test is over, you can eat normally.
- You need to rest well for about 8 to 12 hours before starting all other work again.
- If you are a breastfeeding mother , you should stop breastfeeding your baby for 24 hours after the contrast fluid is injected.
Are there any risks in this?
As with any procedure, there are some minor risks involved in inserting a catheter into a blood vessel. These are:
- Damage to the blood vessel, which can cause internal bleeding.
- Bruising or bleeding where the catheter was inserted.
- Infection.
Other risks of a cerebral angiogram include:
- Allergic reaction to contrast fluid : This is very rare. If it does happen, the radiologist will know how to treat it.
- If you have diabetes mellitus or kidney disease , the contrast fluid may damage your kidneys : In most cases, your kidneys will start working normally again within five to seven days after the test.
- A blood clot may form around the tip of the catheter: This is also rare. If this happens, the clot could block your artery. Your doctor may need to perform surgery to remove it.
- Stroke : If a fatty layer (plaque) in a blood vessel wall breaks loose due to the catheter and blocks blood flow to the brain, a stroke can occur. This is also very rare (less than 1%) .
Your doctor will talk to you about these risks before the test. If you have any concerns or questions, don't be afraid to ask.
What does the investigation report say?
Healthcare providers order a cerebral angiogram for a variety of reasons. So, depending on the reason for your test, the results in your report may vary.
Generally, if the contrast fluid leaks out of a blood vessel, it may be a sign of bleeding.
If your arteries are narrowed or blocked, it can cause:
- Cholesterol deposits (plaque - cholesterol deposits) .
- Vasospasm - sudden, severe constriction of the arteries in the brain.
- Hereditary diseases.
- Blood clots that caused a stroke.
If blood vessels are in unusual places, it can cause:
- Brain tumors.
- Bleeding inside the head.
- An aneurysm.
- Arteriovenous malformation.
However, a radiologist will analyze the images from the test and write a report about what they found. They will send that report to the doctor who ordered your cerebral angiogram. That doctor will then discuss the results with you.
You may need to have another test or some other tests. If so, your doctor will explain the reason to you.
When should I call the doctor?
If you experience any of these symptoms after the test , you should tell your doctor immediately :
- Weakness or tingling in the muscles of your face, arms, or legs .
- It seems to get stuck when talking .
- Vision problems .
- Signs of infection at the catheter insertion site, for example, if the area is warm, red, or has changed color.
- Dizziness .
- Chest pain .
- Difficulty breathing .
- Skin rash .
Is this considered surgery?
A cerebral angiogram is not considered surgery . It is a minimally invasive diagnostic procedure.
In the medical world, surgery is when a surgeon cuts or destroys tissue in your body to make a change. A cerebral angiogram involves making a small incision to insert a catheter, but it doesn't actually change any tissue in your body for a medical purpose.
So, let's remember the most important things, shall we?
A cerebral angiogram is a very useful tool for finding problems with the blood vessels inside your head. If you are scheduled to have this test, don't be afraid or have any questions. Ask your doctor anything. They are there to help you and take good care of you. Taking care of your health is the most important thing.
` Brain angiogram, cerebral angiogram, brain blood vessels, brain tests, catheter, contrast dye, stroke, aneurysm
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