Cerebral angiography: MedlinePlus Medical Encyclopedia

P Cerebral angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the brain.

T How the Test is Performed
P Cerebral angiography is done in the hospital or radiology center.
- You lie on an x-ray table.
- Your head is held still using a strap, tape, or sandbags, so you DO NOT move it during the procedure.
- Before the test starts, you are given a mild sedative to help you relax.
- An electrocardiogram (ECG) monitors your heart activity during the test. Sticky patches, called leads, will be placed on your arms and legs. Wires connect the leads to the ECG machine.
P An area of your body, usually the groin, is cleaned and numbed with a local numbing medicine (anesthetic). A thin, hollow tube called a catheter is placed through an artery. The catheter is carefully moved up through the main blood vessels in the belly area and chest into an artery in the neck. X-rays help the doctor guide the catheter to the correct position.
P Once the catheter is in place, the dye is sent through the catheter. X-ray images are taken to see how the dye moves through the artery and blood vessels of the brain. The dye helps highlight any blockages in blood flow.
P Sometimes, a computer removes the bones and tissues on the images being viewed, so that only the blood vessels filled with the dye are seen. This is called digital subtraction angiography (DSA).
P After the x-rays are taken, the catheter is withdrawn. Pressure is applied on the leg at the site of insertion for 10 to 15 minutes to stop the bleeding or a device is used to close the tiny hole. A tight bandage is then applied. Your leg should be kept straight for 2 to 6 hours after the procedure. Watch the area for bleeding for at least the next 12 hours. In rare cases, a wrist artery is used instead of the groin artery.
P Angiography with a catheter is used less often now. This is because MRA (magnetic resonance angiography) and CT angiography give clearer images.

T How to Prepare for the Test
P Before the procedure, your provider will examine you and order blood tests.
P Tell the provider if you:
- Have a history of bleeding problems or take medicines that are blood thinners
- Have had an allergic reaction to x-ray contrast dye or any iodine substance
- May be pregnant
- Have kidney function problems
P You may be told not to eat or drink anything for 4 to 8 hours before the test.
P When you arrive at the testing site, you will be given a hospital gown to wear. You must remove all jewelry.

T How the Test will Feel
P The x-ray table may feel hard and cold. You may ask for a blanket or pillow.
P Some people feel a sting when the numbing medicine (anesthetic) is given. You will feel a brief, sharp pain and pressure as the catheter is moved into the body.
P The contrast may cause a warm or burning feeling of the skin of the face or head. This is normal and usually goes away within a few seconds.
P You may have slight tenderness and bruising at the site of the injection after the test.

T Why the Test is Performed
P Cerebral angiography is most often used to identify or confirm problems with the blood vessels in the brain.
P Your provider may order this test if you have symptoms or signs of:
- Abnormal blood vessels (vascular malformation)
- Aneurysm
- Narrowing of the arteries in the brain
- Vasculitis
P It is sometimes used to:
- Look at blood flow to a tumor
- Evaluate the arteries of the head and neck before surgery
- Find a clot that may have caused a stroke
P In some cases, this procedure may be used to get more detailed information after something abnormal has been detected by an MRI or CT scan of the head.
P This test may also be done in preparation for medical treatment (interventional radiology procedures) by way of certain blood vessels.

T What Abnormal Results Mean
P Contrast dye flowing out of the blood vessel may be a sign of bleeding.
P Narrowed arteries may suggest:
- Cholesterol deposits
- A spasm of a brain artery
- Inherited disorders
P Out of place blood vessels may be due to:
- Brain tumors
- Bleeding within the skull
- Bulging of a blood vessel in the brain (aneurysm)
- Abnormal connection between the arteries and veins in the brain (arteriovenous malformation)
P Abnormal results may also be due to:
- Cancer that started in another part of the body and has spread to the brain (metastatic brain tumor)
- Syphilis infection of the brain (neurosyphilis)

T Risks
P Complications may include:
- Allergic reaction to the contrast dye
- Blood clot or bleeding where the catheter is inserted, which could partly block blood flow to the leg
- Damage to an artery or artery wall from the catheter, which can block blood flow and cause a stroke (rare)
- Damage to the kidneys from the IV contrast

T Considerations
P Tell your provider right away if you have:
- Weakness in your face muscles
- Numbness in your leg during or after the procedure
- Slurred speech during or after the procedure
- Vision problems during or after the procedure

T Alternative Names
P Vertebral angiogram; Angiography - head; Carotid angiogram; Cervicocerebral catheter-based angiography; Intra-arterial digital subtraction angiography; IADSA

T Images
- Brain
- Carotid stenosis, x-ray of the left artery
- Carotid stenosis, x-ray of the right artery

T References
P Adamczyk P, Liebeskind DS. Vascular imaging: computed tomographic angiography, magnetic resonance angiography, and ultrasound. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 40.
P Chernecky CC, Berger BJ. C. In: Chernecky CC, Berger BJ, eds. Laboratory Tests and Diagnostic Procedures. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:266-432.

T Review Date 7/3/2016
P Updated by: Jason Levy, MD, Northside Radiology Associates, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

