Cerebral angiography, also known as a cerebral angiogram, is a critical technique for examining the blood vessels of the brain. This method is particularly important for the diagnosis and treatment of vascular diseases. Detailed images are obtained to provide accurate and clear analysis.
Recently, this technology is used not only for diagnostic purposes but also plays an active role in various therapeutic interventions. Thus, it offers minimally invasive options for patients.
| Imaging Method | Cerebral Angiography |
| Definition | An invasive radiological imaging method that provides detailed visualization of cerebral vessels and is used to diagnose vessel occlusions, aneurysms, and vascular malformations. |
| Applications | Used for aneurysms, arteriovenous malformations (AVM), vessel occlusions, vessel stenoses, post‑traumatic vessel injury, and evaluating tumor vascularity. |
| Procedure | Typically accessed via an artery in the groin or arm with a catheter; once the catheter reaches the cerebral vessels, contrast is injected and X‑rays are taken. |
| Advantages | Provides a detailed map of cerebral vessels; a reliable method for definitive diagnosis of aneurysms, occlusions, and vascular anomalies. |
| Side Effects | Allergic reaction to contrast, bleeding or hematoma at the entry site, rarely stroke, infection, and risk of kidney function impairment. |
| Accuracy | Highly accurate in detecting aneurysms and vascular malformations; considered the gold standard in diagnosis. |
| Alternatives | MR angiography (MRA), CT angiography; less invasive alternatives for cerebral vessels, though with lower detail than angiography. |
| Related Conditions | Aneurysm, arteriovenous malformation (AVM), stroke, vessel occlusion, vasculitis. |
| Follow‑Up | Regular cerebral angiography may be required post‑treatment to monitor treated vessel issues and aneurysms. |
| Preparation | Kidney function should be assessed; patient must fast; pressure applied to entry site post‑procedure and bed rest recommended. |
Prof. Dr. Özgür KILIÇKESMEZ
Interventional Radiology / Interventional Neuroradiology
Cerebral Angiography: Detailed Examination of Brain Vessels
Cerebral angiography is a method used to obtain detailed images of the brain’s blood vessels. This procedure is especially helpful in identifying serious vascular anomalies such as aneurysms. Catheter and X‑ray technology are key tools in this process.
During the procedure, contrast agent is injected into the vessels, allowing clear visualization of vascular structures and any stenoses, occlusions, or other abnormalities.
When Is Cerebral Angiography Performed?
Cerebral angiography is an essential method used in the diagnosis of various brain diseases. It is chosen specifically to identify abnormal conditions of the cerebral vessels. This procedure plays a critical role in disease detection and in formulating intervention plans. Cerebral angiography is performed in the following situations:
- Aneurysm: when cerebral vessels balloon out.
- Vessel Stenosis: to detect narrowing in cerebral vessels.
- Vasculitis: effective for diagnosing inflammatory vessel diseases.
- Arteriovenous Malformation: to identify abnormal connections between vessels.
- Thrombosis: important for detecting clots in cerebral vessels.
- Vasospasm: to assess vessel spasms.
- Occlusion: preferred when cerebral vessels are completely blocked.
- Intracranial Hemorrhage: used in cases where other imaging methods are insufficient, such as brain bleeding.
This method is vital in emergencies requiring rapid intervention. Cerebral angiography enhances early diagnosis and treatment options.
Why Is Cerebral Angiography Done?
- Patient with sudden right‑side weakness treated by angiographic clot removal at 3 hours, speech and paralysis improved by next day, discharged after one week. Note: This treatment can be applied within 6 hours of stroke onset—timeliness is crucial!
Cerebral angiography is a fundamental method in the diagnosis and treatment of many brain diseases. Pathological changes in cerebral vessels can be detected with high sensitivity using this method.
- Assessing risk in patients prone to stroke,
- Evaluating blood flow in brain tumors,
- Detailed examination of edema and other intracranial pressure‑related issues.
Additionally, this technique allows clear imaging of:
- Arterial tears,
- Intracranial pressure increases,
- Conditions like hydrocephalus due to fluid accumulation.
When severe headache, speech disturbances, visual problems, or balance loss are evaluated with cerebral angiography, accurate diagnosis of underlying diseases is ensured. This enables determination of disease progression and planning of appropriate treatments.
Risks and Potential Harms of Cerebral Angiography
The cerebral angiography procedure carries various risks that can have significant consequences for patient health. The contrast agent used may cause allergic reactions. Particularly in diabetic or renal patients, the risk of kidney damage from the contrast agent increases. Complications that may arise during catheter insertion include:
- Vessel injury
- Bruising
- Bleeding
- Infection
Furthermore, if the catheter tip causes a clot, there is a risk of arterial occlusion requiring surgical intervention. If the catheter dislodges plaque from a vessel wall, stroke risk increases.
Although rare, stroke is a recognized complication of this procedure. Finally, there is a small risk of arterial perforation leading to internal bleeding. These risks necessitate careful management of the procedure and continuous monitoring of patients.
Steps of the Cerebral Angiography Procedure
The procedure begins with positioning the patient on the angiography table. The patient’s head is secured with special supports to prevent movement. Sedation is administered to ensure comfort during the procedure, which is monitored continuously with an ECG. The groin area is typically the access site:
- The groin area is cleaned and sterilized to reduce infection risk.
- Local anesthesia is applied for pain control.
- A thin, flexible catheter is advanced from the femoral artery toward the major chest and neck vessels.
This stage is performed meticulously under fluoroscopic guidance with a guidewire. After catheter placement, monitoring begins:
- Contrast is injected and flow is observed via X‑ray.
After the procedure, the catheter is removed and pressure is applied to the groin to prevent bleeding. The site is bandaged tightly, and the treated leg remains immobilized for a period. Typically, the procedure is completed in one day, with discharge based on patient condition.
Preparations for Cerebral Angiography
Preparations before cerebral angiography are crucial to minimize potential risks during and after the procedure. Patients should fast for four to six hours prior to the procedure to enhance contrast efficacy.
- All medications, especially anticoagulants, must be reported to the physician. Some medications may be paused temporarily.
- Patients with renal impairment must inform their doctor due to contrast-related risks; additional renal function tests may be required.
- Patients who are or may be pregnant should inform their physician so that radiation protection measures can be taken for mother and fetus.
This preparation ensures the angiography is conducted safely and effectively. Each step can be tailored to the patient’s health status, so clear communication with the physician is essential.
Post‑Angiography Care
After cerebral angiography, patients require careful monitoring. Immediately following the procedure, patients are typically required to lie still for several hours. Pressure is applied or a closure device used at the access site to reduce bleeding risk.
During this period, patients are observed and must report any of the following symptoms immediately:
- Numbness in the face, arm, or leg
- Speech disturbances
- Visual problems
- Signs of infection at the catheter site
- Dizziness
- Chest pain
- Difficulty breathing
Otherwise, patients are generally permitted to resume normal activities 12 hours after angiography. Any abnormalities should prompt immediate medical attention. These precautions reduce complication risks and support a healthy recovery.
Frequently Asked Questions
The cerebral angiography procedure typically takes about 30 minutes. After completion, the patient is closely monitored for a few hours. Most patients can be discharged the same day if no complications arise.
Cerebral angiography is usually performed via an artery in the groin. Local anesthesia is applied to the area, and a thin tube called a catheter is inserted into the vessel. The catheter is then advanced through the vessels to the brain to complete the procedure. This site is preferred due to the larger vessel size, which facilitates catheter navigation.
Cerebral angiography is typically available at hospitals with advanced imaging technology, including university hospitals, large private hospitals, and centers with interventional neuroradiologists. These facilities are equipped with experienced radiologists, neurosurgeons, and comprehensive diagnostic equipment such as MRI and CT scanners. They provide extensive pre‑ and post‑procedure care to ensure patient safety and treatment success.
During cerebral angiography, the patient is usually kept awake but comfortable under local anesthesia. However, individual circumstances may vary, and sedation can be used if the patient’s anxiety level is high or if specific conditions warrant it, ensuring patient comfort throughout the procedure.
Patients must fast from midnight before the procedure until the angiography begins. Nothing, including water, should be consumed during this period. Common side effects during the procedure may include nausea, dizziness, and a burning sensation.
Cerebral angiography carries certain risks. Vessel injury can occur due to catheter use. Bruising, bleeding, and infection may also happen. Rarely, a clot can form at the catheter tip, leading to arterial occlusion requiring intervention. Bruising at the entry site occurs in 2–3 out of 10 patients and resolves within three weeks, while serious complications occur at rates below 0.5%.
Cerebral angiography is performed by interventional radiologists who have specialized training and experience. These physicians use intravascular imaging techniques to examine cerebral vessels in detail. Interventional radiologists possess the expertise and knowledge required for this complex procedure.
After cerebral angiography, patients are typically not admitted overnight. They are observed for a few hours post‑procedure and, if no complications arise, are discharged the same day. Hospitalization requirements may vary based on individual health conditions.
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
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