Cerebral and Carotid Angiogram
Date issued: November 2024
For review: November 2026
Ref: B-304/RA/Imaging/Cerebral and Catotid Angiogram v3
PDF: Cerebral and Carotid Angiogram.pdf [pdf] 218KB
This leaflet tells you about having a cerebral and carotid angiogram. It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor but can act as a starting point for such discussions. If you have any questions about the procedure, please ask the doctor who has referred you or the department which is going to perform it.
Referral and consent
The referring clinician should have discussed the reasons for this examination with you in the clinic and you should make sure that you understand these before attending. You will be referred to a Neuroradiologist for this procedure. Neuroradiologists are doctors who have trained and specialised in imaging and x-ray treatments.
Before the procedure you will need to sign a consent form, if one hasn’t been previously completed. This is a legal requirement and ensures that you are fully informed about your procedure.
If after discussion with your hospital doctor or radiologist, you do not want this examination then you can decide against it. If the radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary, then he/she will explain this to you and communicate with the referring clinician. You will return to your referring clinician for review.
At all times the radiologist and referring clinician will be acting in your best interests.
What is a cerebral and carotid angiogram?
An angiogram is an x-ray test used to produce pictures of blood vessels. A cerebral angiogram demonstrates the blood vessels in your head and neck.
Why do you need a cerebral angiogram?
Your doctor has asked for this procedure to be performed to evaluate various vascular conditions, such as an aneurysm (ballooning of a blood vessel), stenosis (narrowing of a blood vessel), or other abnormalities of the blood vessels in the head and neck.
Other tests such as a Doppler ultrasound scan, a CT or MRI scan may have already been performed.
Are there any risks?
An angiogram is a safe procedure and is normally carried out with no significant side effects at all. However, as with any medical procedure, there are some risks and complications that can arise. A small bruise (haematoma) around the site of the needle can occur, but this is quite normal. The bruise might be sore for a few days but will disappear in a few weeks. Rarely a large bruise may develop and require a small operation to drain it.
Occasionally, a tender pulsating swelling called a false aneurysm may develop over a few days due to ongoing leakage from the arterial puncture site. This can usually be treated by an injection of a blood-clotting agent under ultrasound guidance.
Very rarely, some damage can be caused to the artery by the catheter or by displacement of the material causing a blockage in other arteries (an embolus). This may require a small operation or another procedure.
The dye (contrast agent) used during the procedure is very safe, but occasionally can cause damage to the kidneys. This occurs mainly in patients whose kidney function is abnormal already and this will be identified on the blood tests that are performed before the procedure. Allergic reactions to the dye are also possible but are very rarely serious.
If you are pregnant or suspect that you may be pregnant you should notify the department. A baby in the womb may be more sensitive to radiation than an adult. There is no problem with something like an x-ray of the hand or chest because the radiation field is at a safe distance from the foetus. However, special precautions are required for examinations where the womb is in, or near, the beam of radiation. If you are a female of childbearing age the radiographer will ask you if there is any chance of you being pregnant before the examination begins and you will be asked to sign a form. If there is a possibility of pregnancy, then your case will be discussed with the team looking after you to decide whether or not to recommend postponing the investigation.
There will be occasions when diagnosing and treating your illness is essential for your health and where the benefit clearly outweighs the small radiation risks. The procedure may go ahead after discussing all the options with you.
Are you required to make any special preparations?
A cerebral angiogram can be carried out as a day case or inpatient procedure under local anaesthetic.
You may eat and drink as normal unless sedation has been discussed beforehand with the referring team/radiologist.
You may require a fluid drip to help your kidney function before the angiogram.
Before coming into hospital, you will have been asked about certain risk factors for vascular disease, unless you have to come into hospital as an emergency. These factors include checking your blood pressure; your kidney function and making sure you are not on treatment for diabetes or blood clots.
If you are taking warfarin, rivaroxaban, apixaban, ticagrelor (anticoagulants) this will be stopped before the procedure and you may require admission to hospital to give you an alternative.
If you are diabetic, your doctors will advise you about any changes needed to your normal medication. If you have any allergies or have previously had a reaction to the dye (contrast agent), you must tell the radiology staff before you have the test.
Who will you see?
A specially trained team led by a Neurointerventional Radiologist within the radiology department. Neurointerventional Radiologists have special expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.
Where will the procedure take place?
In the interventional radiology suite, which is located within the radiology department. This is similar to an operating theatre into which specialised X-ray equipment has been installed.
What happens during an angiogram?
Before the angiogram, the Neurointerventional Radiologist will explain the procedure and ask if you have signed a consent form. Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish.
You will be asked to lie on the X-ray table, generally flat on your back. The X-ray machine will be positioned above you. You will have monitoring devices attached to your chest and finger and may be given oxygen.
An angiogram is performed under sterile conditions and the Neurointerventional Radiologist and radiology nurse will wear sterile gowns and gloves to carry out the procedure.
Your skin near the point of insertion, usually the groin area, will be swabbed with antiseptic and you will be covered with sterile drapes. The skin and deeper tissues over the blood vessel will be numbed with local anaesthetic.
A needle followed by a wire and catheter (fine plastic tube) will be inserted into the artery and guided to the correct position to obtain the images required.
Once the interventional radiologist is satisfied with the images, the catheter will be removed. Firm pressure will be applied to the skin entry point, for about ten minutes, to prevent any bleeding. Sometimes a special device may be used to close the hole in the artery.
Will it hurt?
It may sting a little when the local anaesthetic is injected. You may feel a warm sensation for a few seconds when the dye is injected and feel like you are passing urine.
How long will it take?
Every patient's situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. As a guide, expect to be in the X-ray department for about an hour altogether.
What happens afterwards?
You will be taken back to your ward. Nursing staff will carry out routine observations including pulse and blood pressure and will also check the treatment site. You will generally stay in bed for a few hours, until you have recovered and are ready to go home.
However, in certain circumstances you may be required to stay in hospital overnight.
You will need someone to drive you home and ensure that an able-bodied person remains with you until morning.
Other Risks
An angiogram is a very safe procedure but as with any procedure or operation complications are possible. We have included the most common risks and complications in this leaflet.
We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation.
Any exposure to ionising radiation (e.g. X-rays) has the potential to cause cancer later in life. This is much lower than the risk we all have of developing cancer in our life of ~1 in 3 and will be considered by the doctor before your procedure.
For information about the effects of X-rays read the publication: “X-rays how safe are they” on the Health Protection Agency
Finally
Some of your questions should have been answered by this leaflet but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Contact
Interventional Radiology Department
01752 430838 - IR Co-ordinator
01752 432063 – Bookings Clerk
Additional Information
Bus services:
There are regular bus services to Derriford Hospital. Please contact:
Car parking:
Hospital car parking is available to all patients and visitors. Spaces are limited so please allow plenty of time to locate a car parking space. A charge is payable.
Park and Ride:
Buses (1/1A/42C/34) run from the George Junction Park and Ride Mon-Sat (except Bank Holidays) every 15/20 mins from 6am. The last bus leaves the hospital at 11:30pm.
Plympton Park and Ride (52) runs from Coypool Park and Ride.
Parking is free although you will need to purchase a ticket to travel on the bus.
Patient Transport:
For patients unable to use private or public transport please contact The Patient Transport Service:
Devon GP: 0345 155 1009
Cornwall GP: 01872 252211
Comments and Suggestions
We welcome comments and suggestions to help us improve our service.
