Cerebral angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the brain.
Vertebral angiogram; Angiography - head; Carotid angiogram
How the Test is Performed
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.
- Electrocardiogram (ECG) is used to monitor 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.
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.
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.
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).
After the x-rays are taken, the catheter is withdrawn.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.
How to Prepare for the Test
Before the procedure, your health care provider will examine you and order blood tests.
Tell the provider if you:
- Have a history of bleeding problems
- Have had an allergic reaction to x-ray contrast dye or any iodine substance
- May be pregnant
- Have kidney function problems
You may be told not to eat or drink anything for 4 to 8 hours before the test.
You must sign a consent form. Your provider will explain the procedure and its risks. When you arrive at the testing site, you will be given a hospital gown to wear. You must remove all jewelry.
How the Test will Feel
The x-ray table may feel hard and cold. You may ask for a blanket or pillow.
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.
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.
You may have slight tenderness and bruising at the site of the injection after the test.
Why the Test is Performed
Cerebral angiography is most frequently used to identify or confirm problems with the blood vessels in the brain.
Your doctor may order this test if you have symptoms or signs of:
- Abnormal blood vessels (vascular malformation)
- Narrowing of the arteries in the brain
It is sometimes used to:
- Confirm a brain tumor
- Evaluate the arteries of the head and neck before surgery
- Find a clot that may have caused a stroke
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.
This test may also be done in preparation for medical treatment (interventional radiology procedures) by way of certain blood vessels.
What Abnormal Results Mean
Contrast dye flowing out of the blood vessel may be a sign of internal bleeding.
Narrowed arteries may suggest:
- Cholesterol deposits
- A spasm
- Inherited disorders
Out of place blood vessels may be due to:
- Brain tumors
- Bleeding within the skull
- Aneurysm (bulging of the artery walls)
- Arteriovenous malformation
Abnormal results may also be due to:
- Intracerebral hemorrhage
- Metastatic brain tumor
- Optic glioma
- Pituitary tumor
- Primary brain tumors
There is the possibility of complications, including:
- 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
Tell your provider right away if you have:
- Weakness in your face muscles
- Numbness in your leg during or after the procedure
- Slurred speech
- Vision problems
Kessel D, Robertson D. Interventional Radiology Survival Guide. 3rd ed. Philadelphia, PA: Elsevier; 2011.
Zenteno M, Vinuela F. Interventional neuroradiology: Neurological endovascular therapy in hemorrhagic and ischemic strokes. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 33E.
Reviewed 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.