OHSU Logo

Angiogram

What Happens When You Have a Cerebral Angiogram?

Angiogram

Angiogram

Your doctor has requested that the Neurointerventional Service at Oregon Health & Science University (OHSU) perform a study of the blood vessels in your head and neck. This procedure is called a cerebral angiogram or cerebral arteriogram. Your doctor discusses this test with you to fully understand why he performs it.
A cerebral angiogram is normally an out-patient procedure, with the patient being admitted in the morning and discharged home in the afternoon or evening. A cerebral angiogram involves a study of the blood vessels in the head and neck.
The procedure begins by admitting you to the hospital. You will be brought to one of the hospital rooms and a nurse will check you in. You will need to remove all your clothes. You will be provided with a hospital gown, and your privacy will be well protected. We will insert an intravenous (IV) line into a vein in your arm. This IV line is used to give you medicines to help you relax during the angiogram. It also allows your doctor to give you fluids to help rid your body of the dye.

Procedure

When you are brought to the Radiology Department, you will be greeted by the Angiography Technologist and/or Angiography Nurses. You will lay down on a cushioned x-ray table and monitoring devices will be attached to you to measure heart rate, blood pressure, and breathing. Medications can be given through out the procedure, but you will not be asleep. If at any time you are feeling pain or discomfort, or are worried, you should tell the doctor, technologist or nurse so that they can deal with the issue that is concerning you. If you want to fall asleep, it is okay to do so. With attention paid to your privacy, we will shave a small amount of hair from the groin, usually the right side. You will then have this area washed with a cleansing solution and covered with a sterile drape. You must keep your arms and legs relatively still underneath the drapes to not contaminate the drape. Your head will rest on a cushion so that it does not move during the examination, which would cause distortion in the pictures. We use a strip of tape to remind you to hold your head still. The doctor will then place some local anesthetic, or numbing medicine, over the artery in the groin. This causes some stinging when it is first administered, much like one would experience at a dentist’s office. The stinging desists within 15 seconds. The doctor will tell you before he/she gives you this medication.
After the medication is given in the groin, a tiny tube, called a catheter, will be inserted into the artery through a needle. During the placement of the tube in the artery, the numbing medicine should prevent any pain from the tube insertion. Occasionally, there is some discomfort even if the numbing medicine has been placed, but it should be mild and not particularly bothersome. If at any time the pain at the groin is bothersome, you should tell the doctor or the nurse so that they can give you additional medication. The catheter is inserted into the artery in the leg and navigated using x-ray through the body up to the level of the neck. There are no nerves in these arteries and you will have no sensation of the movement of the catheter.
Once the catheter is in the correct artery in your neck, a small amount of contrast dye will be injected and pictures will be taken with the x-ray machine. During the injection of the contrast dye, you may feel the sensation of warmth over one side of your face or the other. Most everyone describes it as a warm sensation. Occasionally, you may see flashing lights in one eye. These flashing lights are normal and relate to the contrast dye. The contrast dyes made today are not nearly as irritating as they used to be a few years ago. The doctor may then move the catheter into another artery that is necessary for your examination.
During the course of the angiogram from the beginning to end, medications may be given to you to help take away any discomfort and to help you relax during the procedure. If you experience anxiety or discomfort, please communicate that to the doctor, technologist, or nurse.
If your family or friends accompany you to your angiogram, they should come with you from your room to the Radiology Department where the angiogram is being performed. There is a waiting area close to the Radiology Department and progress reports will be sent out to the family members or friends if you so wish. The doctor will discuss the results of this test with everyone if that is what you desire.

Post-Procedure

After the examination or study is finished, the doctor will painlessly remove the catheter from the artery. The doctor will apply pressure to your leg at the catheter insertion site for about 15 minutes to stop any bleeding. The hole in the artery is very small so bleeding is rarely a problem. You need to lay flat and keep your leg straight for 6 hours, which allows the small hole in the artery time to completely seal up. At the end of the six hours, you may stand up and walk around. And, if you are feeling well, you may go home. Someone else must drive you home.
Once the procedure is finished and you are back in your room, you can usually eat and drink plenty of fluids whatever you feel like. If you need to go to the bathroom during the six hour waiting period, you usually do, your nurse will assist you. Most people can use either a bed pan or a urinal. Occasionally it is necessary to place a small tube into the bladder to aid you in emptying your bladder.
After you are discharged from the hospital, you should not lift any heavy objects for 48 hours. You may walk as much as is comfortable, but you should not engage in any strenuous activities such as: running, bicycling, or lifting weights for three days. If you feel completely recovered, you may drive a car the next day.

Risk of Angiography

Your doctor has asked us to perform a test because he/she feels that there is no good alternative test that will provide the information the doctor needs in order to direct your care.The risk of angiography is extremely small. However, when catheters are put in blood vessels there is always some small risk. The risks primarily relate to placing the needle into the artery in the leg. There is a small risk that the artery could be damaged, bleeding could occur, or you will have pain and discomfort with this procedure. Bruises form if there is some bleeding underneath the skin. Occasionally this bleeding can be quite large, going from the lower part of the belly down into the thigh. If this occurs, it usually resolves within a few weeks. Contrast dyes have markedly improved over the last few years so that allergic complications and the toxicity of the dye have been greatly reduced. Despite these advances there is still a risk of a life threatening allergic reaction to the dye. If you have ever had a contrast allergy in the past or are allergic to iodine or shellfish (which contain iodine), you should let your doctor know.
Generally these types of allergies can be prevented by pre-treating you with steroids and antihistamines. However, it is important for YOU to let your doctor know this before the procedure. Whenever catheters are placed in blood vessels in the neck leading up into the brain there is always a small risk of damage to those blood vessels and from that damage, a stroke can occur.
While your doctor does everything possible to reduce the risk of a stroke from an angiogram, the risk can never be completely eliminated. Strokes can be mild or even unnoticeable, but occasionally they can produce more severe deficits such as paralysis, blindness, or may even result in the loss of life. However, these severe complications are exceedingly rare and your doctors feel that risk of these complications is much less than the risk of not understanding the blood vessels in your head and neck. During the angiogram, you should feel free to ask the doctor or the technologist questions as they arise. While the x-ray pictures are being taken, it is important for you to hold very still so that the computer does not get fuzzy images. The technologists will instruct you exactly when the pictures are being taken so that you can hold your breath, not move your jaw, or swallow. These still periods last about 10 seconds. Moving, coughing, or talk while the pictures are being taken, will not hurt you, but the pictures will not be of excellent quality and may need to be repeated. While the pictures are not being taken, you may be able to ask the doctor and technologists questions, although occasionally they will ask you to hold still or not talk.

Angiogram Results

The results of the cerebral angiogram should be immediately available after the procedure. The doctors will discuss the findings with you when you are fully awake. In some cases we can provide you with selected copies of the pictures. We ask that you show these images to your primary care doctor and the doctor who referred you to us. Before leaving the hospital you should know
1) the results of this test and
2) what your followup should be after the test has been completed.
If anything is not clear to you please ask your doctors before you leave the hospital.

We hope this information sheet on having a cerebral angiogram provides you with basic information on the procedure and clarifies any questions you night have on what you should expect.
During the day we can be reached at 503-494-7736.
If it is after hours please call the paging operator at 503-494-9000 and ask for the Neurointerventional services or the Neurosurgeon on call to be paged.
If it is an emergency go to the nearest emergency room.

 

<< more topics here