Perhaps your doctor has told you that you need to have a special test done on the blood vessels in your brain. Did you feel a little scared when he told you the name of the test was 'Cerebral Angiogram'? Or did you have trouble imagining what it was like when you heard the name? There is no reason to be afraid or worried. In this article, we will talk exactly and simply about what it really is, how it is done, and why it is done.
What is a cerebral angiogram?
Simply put, a cerebral angiogram is a special test that looks for problems with the blood vessels in your brain. Just like a map of a city, this test allows doctors to see a clear, map-like picture of the blood vessels that carry blood to your brain.
This test is performed by specially trained doctors, usually in an operating room-like environment. Here's what happens:
1. The doctor inserts a very thin plastic tube called a catheter into a large blood vessel in your wrist or groin.
2. Then, a contrast material , a special dye, is injected through the tube. This dye makes your blood vessels show up very clearly on the X-ray images.
3. While you lie on the examination table, the doctor takes a series of X-ray pictures as this dye passes through your blood vessels.
The images taken with this method provide a much more detailed and clearer picture of the blood vessels in the brain than either a CT scan (Computed Tomography) or an MRI scan (Magnetic Resonance Imaging) that we usually perform.
Why do we need to do this test?
Sometimes this test is done just to find out what exactly a disease is. Other times, it is also used to treat certain medical conditions. Mainly, it is used to confirm whether there are any abnormalities in the blood vessels in the brain.
| Diagnosing conditions | Simply put... |
|---|---|
| Brain Aneurysm | Find a place in the brain where a blood vessel has become bulging and weak. |
| Atherosclerosis | Check to see if fat (cholesterol) has deposited inside the blood vessels and narrowed them. |
| Arteriovenous Malformation | Check for abnormal tangles in the arteries and veins (the veins that carry good blood and bad blood) in the brain. |
| Vasculitis | Check to see if the walls of the blood vessels are swollen and inflamed. |
| Stroke | To find the exact location where a blood clot has formed and blocked a blood vessel in the brain. |
In addition, this test is performed for several other reasons:
- Check the condition of your blood vessels before having surgery on your head, neck, or brain.
- If there is a brain tumor, find out exactly how and from which veins it is supplied with blood.
- Learn more about an abnormality seen on another scan (like an MRI or CT scan).
How do we prepare before the test?
Before having this test, your doctor will make sure it is appropriate and safe for you to have it. They will examine you, possibly do some blood tests, and ask questions about your health history.
You should definitely discuss these things clearly with your doctor. Don't hide anything.
- Tell us about all the medications you are currently taking: This includes vitamins, supplements, and over-the-counter (OTC) medications you take.
- Tell us about any other illnesses you have: even something like a recent fever.
- If you have bleeding problems or are taking blood thinners: Also mention any medications such as pain relievers (NSAIDs).
- About your allergies: Be sure to tell us if you have any allergies, especially to anesthetics, contrast dyes, or anything containing iodine.
- If you are pregnant or suspect you may be pregnant: You should also tell your doctor.
If you are given a sedative to keep you relaxed during the test, you will be instructed to refrain from eating or drinking for four to eight hours before the test. Also, if you are given anesthesia, you will be asked to bring someone to take you home after the test. Follow all of these instructions carefully.
What happens during the test?
Okay, now let's see how this happens step by step. Don't worry, everything will be done with great care and without any inconvenience to you.
1. First, you will be given a special hospital gown to wear.
2. A nurse or radiologist will put a cannula (IV line) into a vein in your arm. This is where you will be given medicine to help you relax, if needed. This will feel like a small ant stinging sensation. Some people, especially children and young adults, may also be given a full dose of anesthesia.
3. Devices will be attached to your body to monitor your heart rate and blood pressure throughout the test.
4. You will be laid on the examination table. Your head will be immobilized with a strap or foam support.
5. The site where the catheter will be inserted (groin or arm) is thoroughly cleaned with an antiseptic solution.
6. Then a numbing medicine is injected into the area. When this is injected, you may feel a slight burning sensation for a few seconds, but then the area will start to feel numb.
7. The doctor makes a very small incision in the skin to insert the catheter.
8. Then, under X-ray guidance, the catheter is inserted into the blood vessel through a very small hole made with a needle. You will feel a slight push at this time, but it will not hurt.
9. Now the doctor will carefully guide the catheter through your veins and into a vein in your neck. You will not feel the catheter going through your body.
10. Once the catheter is in place, the contrast dye is injected through it. You may feel a slight warmth as the dye travels through your body, but this will quickly disappear.
11. Once the dye has entered the blood vessels in your brain, the doctor will take several X-ray pictures. During this time, you must hold your breath and remain still . This is the only way to get clear pictures.
12. After taking all the necessary pictures, the doctor carefully removes the catheter.
13. To stop the bleeding from the catheter insertion site, apply pressure to the site for a while. You may also need to use a closure device to close the small hole.
14. Finally, a small plaster will be applied to the area and the cannula in your hand will be removed.
How long will this take?
The entire test usually takes about one to three hours . In addition, there may be additional time for preparation for the test and observation after the test.
How long does it take to heal?
After the test, you will be kept in a recovery room for a few hours. If everything is fine, you can go home. Your doctor will give you instructions on how to take care of yourself at home. Follow them exactly.
- You can eat normally.
- After the test, you should rest well for 8 to 12 hours . Only then should you begin other work.
- If you are a breastfeeding mother, avoid breastfeeding your baby for 24 hours after the dye is applied.
Are there any risks to this test?
As with any medical procedure, there are some very small risks involved in having a catheter inserted into a blood vessel. However, you should remember that these are very rare and that doctors are very careful about this.
| Risk | Description and what to know |
|---|---|
| Blood vessel damage | There may be bruising, bleeding, or infection at the catheter site. These are usually minor. |
| Allergic reaction to contrast dye | This happens very rarely. If it does, the radiologist knows how to treat it. |
| Effect on the kidneys | If you have diabetes or kidney disease, the dye may have a small effect on your kidneys. However, it usually returns to normal within 5-7 days. |
| Stroke | The catheter can cause a piece of plaque to break off from the wall of a blood vessel and block an artery in the brain. The chance of this happening is very, very low (less than 1%). |
Your doctor will discuss these risks with you before the test. Don't hesitate to ask any questions or concerns you may have at that time.
What do the test results say?
A radiologist will carefully study your X-ray images and create a report. When the doctor who ordered the test receives the report, he or she will discuss it with you clearly.
- If the dye appears to be leaking out of a blood vessel, it may be a bleed .
- If blood vessels are narrowed or blocked, the cause may be cholesterol deposits (plaque) or a blood clot .
- If the blood vessels are bulging or in unusual places, it could be an aneurysm , a brain tumor , or another abnormality.
If something like this happens after the test, call the doctor immediately!
If you experience any of the following symptoms after going home from the test, notify your doctor immediately.
- Muscle weakness or tingling in the face, arms, or legs.
- Slurring or slurring of speech .
- Vision problems .
- Signs of infection, such as warmth, redness, or swelling at the catheter insertion site.
- Dizziness.
- Chest pain.
- Difficulty breathing.
- A skin rash .
If these symptoms are severe, go to the nearest hospital emergency room (ETU) as soon as possible.
Is this a surgery?
No. A cerebral angiogram is not a surgical procedure. It is a minimally invasive diagnostic test. A surgical procedure is a procedure in which a surgeon cuts and changes tissue in your body. This procedure only involves making a very small hole to insert a catheter. It does not change any tissue in your body.
A cerebral angiogram is a very important and valuable test for diagnosing diseases related to the blood vessels in the brain. If you are scheduled to have this test, don't be afraid to ask your doctor any questions you may have.
Take-Home Message
- A cerebral angiogram is a special X-ray test that checks the health of the blood vessels in the brain, not a major surgery.
- It is very important to tell your doctor about all medications you are taking, allergies you have, and other medical conditions before the test.
- This procedure is performed using a thin tube (catheter) and a special dye, and is performed very carefully by specialist doctors.
- The risks of this test are very low, but be aware of them and don't be afraid to ask your doctor any questions you may have.
- If you experience any warning signs after the test, such as weakness or difficulty speaking, call your doctor immediately or go to the nearest Emergency Department (ETU).
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