Cerebral angiogram of the brain

Introduction

This leaflet is for patients scheduled to undergo a cerebral angiogram of the brain.

About cerebral angiogram of the brain

An angiogram is a special x-ray examination where the blood vessels in your body relevant to your problem are shown.

A cerebral angiogram shows the blood vessels in your head and neck.

Usually,vessels do not show up on an ordinary x-ray, so a special dye called contrast medium, is injected into the vessels through a fine plastic tube called a catheter to make them visible.

X-rays are taken during the procedure. These images will assist the doctors in performing the procedure and obtaining diagnostic information.

Who has made the decision for me to have the procedure?

The consultant in charge of your case and the Radiologist performing the angiogram will have discussed your case and come to the conclusion that this is the best way of diagnosing your condition.

You will have the opportunity for your opinion to be taken into account, and if after discussion with your doctors, you do not want the procedure carried out, you can decide against it.

What are the benefits?

Cerebral angiograms provide more detailed images than other non-invasive techniques such as CT angiography and MR angiography. The extra detail helps to make a more accurate diagnosis.

Who will be performing the procedure and other staff you are likely to meet

This procedure will be performed by a Consultant or Specialist registrar in Neuro Interventional radiology.

Radiologists have special expertise in using x-ray equipment and in interpreting the images produced.

They will look at these images while carrying out the procedure to guide the diagnosis or treatment.

The Neuro Interventional Radiologist will be assisted by a radiographer and nurses and / or other Radiology doctors or trainees.

What happens before the procedure?

• You will be admitted to the Radiology Day Unit on the day of procedure.
• A doctor will ask you about your medical history and any medication you are taking, and will explain the test to you and ask for your consent.
• If you are coming to us as a day case, you will be allowed to eat or drink before the test.
• You may have a small needle put into a vein in your arm for painkillers to be given if necessary.
• Standard blood tests may be carried out.
• If you have any allergies you must let your doctor know.
• If you have previously reacted to intravenous contrast medium (the dye used for CT scans), you must also tell your doctor about this.

Medications

If you are taking blood thinning drugs (also known as anticoagulant or antiplatelet drugs) then please inform the Radiology Day Unit on 01223 274287 as soon as you get the appointment. Examples include: warfarin, rivaroxaban, apixaban, edoxaban, aspirin, clopidogrel, prasugrel, ticagrelor, dabigatran, dipyridamole and acenocoumarol.

If you are taking metformin please ask your GP to check your creatinine levels and inform us of the result a week before your angiogram; you may be asked to stop taking your metformin for 24 hours following the procedure.

This procedure involves the use of local anaesthesia.

Most people who have this type of procedure will need to stay in hospital for four hours after the procedure.

What happens during the procedure?

• You will be asked to change into a hospital gown.
• You will lie on an x-ray table, generally flat on your back.
• You will have a monitoring device attached to your finger and will have a blood pressure cuff placed around your arm.
• The procedure is performed under sterile conditions and the Radiologist and scrub nurse will wear sterile theatre gowns and operating gloves.
• Your skin will be cleaned and local anaesthetic given to numb the area and prevent any pain;; they will then put a large sterile drape over the area.
• The radiologist will then put a very small tube (catheter) into the blood vessel in your groin / wrist (the femoral/ radial artery). This is passed through other blood vessels in your body until it reaches your neck. You will not feel it moving inside you. The radiologist will then position the tube into different blood vessels in the neck.
• While this happens, you will receive injections through the catheter of a special dye (called contrast agent) to produce the radiological images required. You may feel a hot feeling from the dye and it can make your bladder feel full.
• Before taking the first picture, the Radiographer will move the equipment around you into the correct position. More pictures are taken throughout the procedure.
• It is very important that you remain still throughout the procedure to ensure the pictures taken are as clear as possible.
• Once the procedure is complete, the catheter will be removed.
• The hole in the vessel will then be closed, often with firm pressure applied to the skin entry point for several minutes, to prevent any bleeding. Sometimes a special device may be used to close the hole in the artery.

How long will I be in the department?

• Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be.
• Generally, the procedure will last approximately 1 hour.
• Some procedures can be performed as a day case and you will be observed in the Radiology Day Unit for around four hours to ensure it is safe for you to go home.

What happens after the procedure?

• Once your angiogram is completed you will usually be transferred to the Radiology Day Unit where you will be looked after by specially trained nurses, under the direction of your radiologist.
• Most people who have this type of procedure will need to stay in bed for four hours after the procedure, until you have recovered and are ready to be sent home.
• The nurses will monitor you closely and regularly check on the arterial puncture site in your groin.
• If you experience pain, sickness, abnormal swellings or are generally feeling unwell, please let the nursing staff know.
• You will be able to eat and drink normally after the procedure.

Possible side effects and additional aftercare

• Please be aware of the following:
  • Bruising at the top of the leg is common following an angiogram. This should go after a few days. If the bruising is excessive or a lump develops after you have been discharged please contact your GP.
  • If you feel unwell, dizzy or light headed or there is active bleeding, press firmly on the puncture site and go to the nearest Accident and Emergency department.
  • You will be advised on when to restart any medication that was stopped prior to the procedure.

Alternative procedures that are available

Other tests to demonstrate blood vessels, for example CT or MR angiography, do not give as much detail. You may have had these other tests already.

You may decide not to have this test or to delay it whilst you make up your mind. For some conditions, delaying may carry additional risk.

Discuss this with the doctor who referred you for your angiogram.

An alternative to this procedure is a decision not to have the angiogram. We will discuss with you the implications of deciding not to have the angiogram.

Getting about immediately after the procedure:

We will try to get you mobile (up and about) as soon as we can to help  prevent complications from lying in bed.

Typically, you will be able to get up after four hours. If we think you will have problems getting about, we will arrange for extra assistance, for example nursing help.

Leaving hospital

You should not drive home after the procedure and for a further 24 hours. Please arrange for someone to drive you home. Someone will also need to be at home with you for the night following the procedure.

Contacts and further information

Please call the nurses on the Radiology Day Unit on telephone number 01223 274287 if you have any questions or concerns about this procedure or your appointment.

Resuming normal activities including work

Most people who have had this procedure can resume normal activities after 24 hours. You will be given more detailed information about any special measures you need to take after the procedure. You will also be given information about things to watch out for that might be early signs of problems such as swelling or pain in the groin.

Risks

Significant, unavoidable or frequently occurring risks of this procedure

• 1 in 100 patients
  • Transient neurological symptoms (headache, limb weakness, difficulty with speech or loss of vision). This will usually last for a few hours although in some cases there is a permanent disability (1 in 200 patients or less).
• 1 in 200 patients
  • Circulatory problems in the leg because of the damage to the femoral artery (e.g. painful swelling of the artery). These problems usually settle with simple treatment like compression of the artery but may require a day in hospital.
  • Damage to the femoral nerve which lies next to the artery in the groin.
• 1 in 500 patients
  • Loss of circulation to the leg from blockage of the artery requiring further treatment.
  • Serious blood loss.
  • Allergic reaction to contrast agent, latex or local anaesthetic. Please let us know if you have any allergies.

Radiation

You have been referred for an x-ray examination to help diagnose/deliver your treatment. A specialist in radiology agrees that this is the best procedure to diagnose/treat your clinical condition and that the benefit of the examination is greater than the risk. The x-ray involves a dose of ionising radiation equivalent to a few months or years of natural background radiation which we are all exposed to every day. Ionising radiation can cause cell damage that may turn cancerous however the risk of this happening from your examination is considered low. Depending on the length of the procedure there may also be a small risk of an excess radiation dose to the skin leading to short term and long term effects (e.g. reddening of the skin and burns). If this happens as a result of this procedure, you will receive further advice following the procedure. The dose delivered will be kept as low as is practicable

For further information please see Imaging-radiology

Accessibility requirements

If you require support for your appointment, e.g. if you find it hard to hear, see or be understood by others, please let the receptionist or healthcare professional know on arrival or contact us by email: cuh.accessibility@nhs.net or telephone: 01223 256998.

Pregnancy status

We have a legal responsibility to enquire if you are pregnant. Any patient aged between 12-55 years will be asked if there is a possibility they could be pregnant. This is important for us to know before you have your examination involving ionising radiation.

You can discuss this with a healthcare professional in private if you wish.

Medications

Please bring all your medications and any packaging (if available) with you. If you are taking blood thinning drugs (also known as anticoagulant or antiplatelet drugs) or time sensitive medications, then please inform the Nurse in Charge in the Radiology Day Unit on 01223 274287 as soon as you get the appointment.

Examples include: warfarin, rivaroxaban, apixaban, edoxaban, aspirin, clopidogrel, prasugrel, ticagrelor, dabigatran, dipyridamole and acenocoumarol.

If you are taking metformin please ask your GP to check your creatinine levels and inform us of the result a week before your angiogram; you may be asked to stop taking your metformin for 24 hours following the procedure.

Can I bring someone with me?

Those accompanying you will be required to stay out of the examination room during the procedure and remain in the waiting area.

Childcare whilst in department

Staff are unable to look after or supervise children whilst your procedure/examination is taking place. Please make alternative arrangements for the care of your children whilst you attend for your procedure/examination. If you attend an appointment with children with no one to look after them whilst you have your examination/procedure, then your appointment will unfortunately have to be cancelled and rescheduled.

Personal belongings

Patients are advised to bring minimal belongings and not to bring valuable items. Any valuable belongings (mobile phone, wallet etc.) will go with the patient while having their procedures and can be secured in a lock box.

How, when and by whom will my results be communicated?

Imaging examinations are reported in order of clinical priority to ensure those with the highest urgency are reported first.

Your referring team or clinician will be responsible for communicating reports back to you.

Test results are made available via MyChart but there is 3 week delay from when an examination has been reported to when it is available on MyChart, in order to allow time for your clinical team to be able to see and action the results prior to them being released to the individual patient.

Alternative procedures that are available

Other tests to demonstrate blood vessels, for example CT or MR angiography, do not give as much detail. You may have had these other tests already.

You may decide not to have this test or to delay it whilst you make up your mind. For some conditions, delaying may carry additional risk. 

Discuss this with the doctor who referred you for your angiogram.

An alternative to this procedure is a decision not to have the angiogram. We will discuss with you the implications of deciding not to have the angiogram.

Contacts/Further information

Please call the nurses on the Radiology Day Unit on telephone number 01223 274287

If you have any questions or concerns about this procedure or your appointment.

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Directions to the department

The Radiology Day Unit is located in the Hospitals outpatients building on level 3, where you will see signs to " Radiology Day Unit". If driving, turn right at the hospital roundabout and follow the signs for the multi-storey car park, or patients can be dropped off at the outpatients entrance.

The CUH Directions mobile app is for patients and visitors.

It helps you to find your way around Addenbrooke’s and the Rosie hospitals, making it easier to locate clinics, wards and other facilities on our campus.

CUH Directions – mobile app

Question, concern or complaint?

Firstly speak to your nurse, doctor or other staff member as soon as you can so they can do their best to put things right straightaway.

If you don’t feel able to speak directly to the people caring for you, contact the patient advice and liaison service (PALS). Please call 01223 216756 9am to 4pm Monday to Friday, via email at cuh.pals@nhs.net, or via a form available via link on the CUH PALS webpage.

PALS is open every weekday, and you can leave a message in the evenings and weekends.

My Chart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on our website: My Chart