What is a Brain Angiogram and why is it done?

by admin | April 18, 2022 6:18 am

Brain Angiogram is a minimally-invasive procedure undertaken to detect or confirm abnormalities in blood-vessels of the brain, head or neck. Angiogram is also called angiography or arteriogram, and brain angiogram is also called Cerebral Angiogram or Carotid Angiogram. Such a procedure is also done for blood vessels of the heart, kidneys and legs.

Why is Cerebral Angiogram required?

A. A cerebral arteriogram is used to detect changes in blood vessels inside or leading to – the brain. These changes include:

• Atherosclerosis – this is the most common. Here, arteries get narrowed due to build-up of plaque deposits on their inner walls.
• Stenosis: Narrowing of blood vessels due to reasons other than atherosclerosis.
• Aneurysm[1]: In this, there is a balloon-like bulge of a blood vessel, which can burst, causing bleeding in the brain
• Vasculitis: Inflammation of the blood vessels which causes them to narrow down
• Arteriovenous malformation: This is an abnormal connection between the arteries and veins
• Thrombosis: A blood clot occurring within a blood vessel, which can eventually block blood flow
• Vasospasm: A spasm of the blood-vessel which causes it to narrow down
• Complete blockage of a blood vessel due to one or more reasons.

B. There are certain conditions that cause displacement of blood vessels in the brain. A Cerebral Angiogram can help detect or confirm the same. These include:

• Tumors in the brain[3], head or neck
• Brain stroke[4]
• Edema or swelling in the brain tissue
• Herniation: In this condition, swelling, bleeding, or other reasons cause pressure within the brain and hence dislocation of the brain tissue
• Vascular dissection: A tear in an artery
• Increased pressure within the brain for one or more unexplained reasons
• Hydrocephalus: In this, fluid starts accumulating in the brain, typically in infants, eventually causing brain damage if left untreated.

C. Cerebral angiography may also help doctors understand the cause of certain symptoms like:

• Severe and recurring headaches
• blurred or double vision
• loss of memory
• dizziness
• slurred speech
• loss of balance or coordination
• weakness or numbness in parts of the body

D. Before certain procedures

• To evaluate arteries of the head and neck before surgery in these areas.
• To prepare for surgical removal of a tumor.
• An MRI or CT of the head can reveal abnormalities such as the blood supply to a tumor. A Cerebral angiogram may then be done to provide additional information
• To prepare for a minimally-invasive treatment of some vessel abnormality.

Benefits

• Angiography eliminates the need for incisional surgery. However, if surgery is required, the angiogram provides enough information for a precise surgery
• Results from cerebral angiography are more accurate and reliable than those produced by Carotid Doppler Ultrasound, or any other noninvasive procedure to create images of blood vessels.
• The minimally-invasive procedure uses a catheter, so doctors can combine diagnosis and treatment in one procedure.
• The X-rays used in this procedure has no side effects and does not leave any residual radiation in the body, later

Preparing for the procedure

The procedure is generally done using local anesthesia for adults and general anesthesia[5] for minors. It’s generally an out-patient procedure unless the patient develops complications, in which case he/she must be hospitalized for monitoring. He/she may not be allowed to eat or drink anything the previous night. The patient must check in a couple of hours before the procedure. He/she must clear the bladder (urinate) as the procedure and returning to normalcy can take 3-5 hours.

• If you are the patient, you must tell the doctors before the procedure if you have a history of bleeding disorders, or if you are taking any anticoagulant (blood-thinning) medicines for some condition, aspirin, or any medicine that affect blood clotting. You may be asked to stop these medicines one or more days before the procedure.
• If you are a woman, you must tell the doctors if you are pregnant or think you may be.
• You must tell the radiologist if you are allergic to contrast dye (which will be used in the procedure), iodine or shellfish.
• You must tell the radiologist if you are allergic to any medicines, anesthetic agents (local and general), tape and latex.

Thereafter you will sign a consent form for the procedure. The doctors will do a blood test to see how long your blood takes to clot, and any other abnormalities in the blood.

The Procedure

• The doctor[6] will first stabilize your head using sandbags, strap or tape. Then the doctor will choose a location to insert the catheter. This is usually the groin area, but it can also be the arm or neck sometimes. The catheter is a thin tube around 1/8^th inches in diameter.
• A hole is made in the skin at the spot chosen, and the catheter is pushed into an artery there and slowly threaded all the way to the brain. Once the doctors feel that the catheter has reached the desired location inside the brain, a contrasting dye, which is a chemical, is pumped into the catheter using a special machine.
• Multiple X-ray scans of the head and neck are then taken. The dye along with the X-ray machine help create a clear image of the arteries. Based on the findings, the doctors may even perform some intervention.
• Thereafter, the catheter will be removed and pressure applied over the spot to prevent bleeding in that artery. Then, a dressing is applied to the site. A sandbag or some heavy item will be placed over the site to prevent bleeding or formation of hematoma (bruise) at the site.

Risks

• There is a very small risk of cancer due to exposure to radiation from the X-rays.
• There is a small risk of allergic reaction to iodine, or contrasting dye, but the doctors are well-equipped to handle this.
• There is a temporary loss of kidney function (5 to 7 days) due to the contrasting dye used. That is why, patients with kidney disease are not advised this procedure unless inevitable.
• Any minimally-invasive procedure carries the risk of damage to the blood vessel, bleeding or bruising at the site, and infection. The doctors are aware of this and will take necessary precautions.
• There is a small risk of blood-clot forming around the tip of the catheter. This can block the artery, so a surgery may be required to reopen the vessel.
• If the catheter dislodges plaque from a vessel wall, it can block blood flow within the brain and cause a stroke.
• In case the catheter punctures the artery, which is very rare, there is internal bleeding caused.
• The catheter tip can separate material from the inner lining of the artery. This will trigger a block downstream in the blood vessel.

Complications

• Transient ischemic attack (TIA) or mini stroke
• Hemiplegia or paralysis only on one side of the body

Post-procedure care

Immediately after the procedure, you will have to lie down flat in a recovery room for several hours. If the site of catheter insertion was in the hand or groin, that hand or that side of the body must be kept straight for up to 12 hours. If the site was in the neck, the doctors will watch closely for difficulty in swallowing, breathing problems or hoarseness. A nurse will monitor your vitals constantly.

Medicines may be given to relieve the pain or discomfort from lying down for so long. You must consume plenty of fluids to flush out the dye. There may be restrictions on diet and head movement for a few days after discharge. Shower, hot-bath and strenuous activities are restricted for a day or 2 after the procedure.

At home, you need to monitor the site for redness, swelling and bleeding. In case the site was in the hand or groin, you must monitor your hands and legs for change in temperature, numbness, loss of function, tingling, pain and change in color.

And in case you are displaying any of these symptoms, you should immediately call your doctor as these could be signs of a stroke or other complications:

• Fever and/or chills that cause shivering
• Excessive pain, bleeding, redness, swelling or drainage from the injection site
• Coldness, tingling sensation or numbness in the hands and legs
• Dizziness
• Slurred speech
• Blurred vision
• Numbness or muscle weakness
• Chest pain

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Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals

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NOTE: Take medications only when prescribed by your doctors, self-medication must be avoided under any circumstances.

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Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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