Cerebral angiogram | North Bristol NHS Trust

Your doctor has requested that you have a cerebral angiogram. We hope this information will answer some of the questions you may have about this procedure.

What is a cerebral angiogram?

An angiogram is a procedure to look at blood vessels using X-rays. A special dye is injected into the blood vessels while we take X-rays. We will look at blood vessels in your head and neck.

Why do I need to have a cerebral angiogram?

The purpose of this procedure is to enhance and increase the information that the doctors may already have from MRI, CT or Ultrasound, in order to have a detailed map of your head and neck circulation.

What happens before the procedure?

You can continue to eat and drink as normal unless we tell you differently.
If you are taking any medicines to thin your blood (including antiplatelets) please contact the Imaging department before the appointment. The number is on your appointment letter.
Please plan for someone to collect you from the hospital and take you home by car. We ask you not to travel home by bus. You cannot drive for 24 hours after the angiogram and someone should stay with you at home for the first 24 hours. Please tell us if this is not possible.

On the day of the procedure:

You will arrive at the Imaging Department (Gate 19) and be brought into our day case area.
Please bring a list of the medicines you usually take. You do not need to stop taking your usual medicines unless we have told you differently.
Please tell us if you have any allergies.
A doctor will talk you through the angiogram and the benefits and risks to you. You can ask any questions about the angiogram. If you choose to have the procedure you will need to sign a consent form.
A doctor will talk you through the angiogram and the benefits and risks to you. You can ask any questions about the angiogram. If you choose to have the procedure you will need to sign a consent form.
You will change into a hospital gown.
You will be taken to the procedure room and asked to lie on the X-ray table. The procedure may take up to one hour. There will be a small team of nurses, doctors, and radiographers with you.
The angiogram is usually done while you are awake.
A cerebral angiogram can be done through a blood vessel in the wrist or leg - the doctor will discuss this with you beforehand.
We will attach monitoring equipment to you so we can check your blood pressure, heart rate, and oxygen levels.
The nurse will clean the area at the top of your leg or wrist and cover you with sterile drapes. The X-ray machine will move around you but will not touch you.
The doctor will inject local anaesthetic into the area at the top of your leg or wrist, which may briefly sting and then go numb. After this, you may just feel a pushing sensation when a small plastic tube (catheter) is inserted into your blood vessel.
Once the catheter is in the correct place, an X-ray dye is injected into the different blood vessels and X-rays are taken.
The injection of the X-ray dye may give you a warm feeling, a strange taste in your mouth, and flashing lights behind the eyes for a short time.
The injections will be repeated until we have all the information we need.
At the end of the procedure the catheter will be removed from your wrist or leg.

What happens after the procedure?

If your procedure is done through a blood vessel in the wrist

An inflatable wrist band will be used to prevent any bleeding.
You will need to wear this for 1-2 hours but you can sit up and walk around immediately after the procedure.
You will then be transferred back to the day case unit where the nursing team will monitor you closely until you are ready to go home.
If you feel the wrist puncture site swelling or becoming more painful, please tell the nurse.
You may have some bruising around the puncture site, but this should fade over a few days.

If your procedure is done through a blood vessel in the leg

One of the team will press on the leg vessel for 10 - 15 minutes to prevent any bleeding.
You will then be transferred back to the day case unit where you will have to lie flat for 2 hours.
After 2 hours you will be able to sit up, but you will still need to stay in bed for another 2 hours.
You will not be able to get out of bed for a total of 4 hours after the procedure.
During this time the nursing team will help you go to the toilet if needed.
If you are going to sneeze, cough, or laugh, you must put firm pressure over the puncture site to protect the blood vessel from bleeding.
If you feel the leg puncture site swelling or becoming more painful, please inform the nurse.
You may have some bruising around the puncture site, but this should fade over a few days.
Avoid activities during the next three to five days which may strain your leg, such as running or lifting.

What are the risks associated with cerebral angiograms?

Potential complications are uncommon but include:

1 in 1000 risk of a stroke with permanent symptoms.
1 in 3000 risk of damage to the blood vessels in the neck which requires treatment.
1 in 3000 risk of infection at the wrist or leg blood vessel puncture site.
1 in 1500 risk of bleeding from the wrist or leg blood vessel puncture site which requires treatment such as a blood transfusion or an operation.
1 in 750 risk of damage to the leg or wrist blood vessel. If this happens we may need to repair the damaged blood vessel, to prevent severe swelling or to maintain good blood supply to the affected limb.
1 in 1500 risk of an allergic reaction to the X-ray dye, this could result in skin rash or breathing difficulties.
1 in 20,000 risk of cancer related to the X-rays used in this procedure.
If a wrist blood vessel is tried first, there is a chance we need to switch to using a leg blood vessel during the procedure. This happens in around 1 in 20 cases.

These risks are more likely in older patients or those who have the procedure in an emergency (if they have bleeding in or around the brain). Your neuroradiologist will discuss these with you again on the day of your procedure. You will be asked to sign a consent form to confirm you have understood these risks.

What happens next?

The neuroradiologist will examine all the images very carefully. They will write a report and possibly discuss findings with the doctor in charge of your case.
You will get a follow-up appointment.
If you have any symptoms you are concerned about, please contact the Imaging department (number on your appointment letter). Or contact your GP or the Emergency Department.
We recommend that you do not travel internationally for up to 2 weeks following the procedure.
Finally, we hope this information is helpful. If you have any questions either before or after the procedure the staff in the Imaging department will be happy to answer them.