Radiology - Your Cerebral Catheter Angiogram

Why do I need a catheter angiogram?

A cerebral angiogram is a very specialised way of viewing the blood vessels of the brain.

What does the procedure involve?

Blood vessels are not normally seen on x-rays; therefore, a colourless dye (contrast) is injected in to the vessels whilst an x- ray machine acquirees images.

These images allow the specialised doctors to examine the blood supply in detail.

A catheter angiogram is a minimally invasive technique of acquiring these images and provides the best quality pictures of your arteries.

To perform the angiogram a specialised doctor will normally insert a short tube into one of the arteries in your groin.

A catheter (long plastic tube) is then carefully steered into the blood vessels they wish to examine. The will then inject the contrast and acquire the images.

Who will do the cerebral angiogram?

A specially trained doctor called an Interventional Neuroradiologist will undertake the procedure.

The team helping to complete the angiogram consists of interventional nurses, radiographers and anaesthetists who are all highly trained in helping the Radiologist and making you, feel at ease.

Where will the procedure take place?

The procedure is undertaken in the angiographic theatre within the radiology department and can be done as a day case appointment.

Most people can return home on the evening of the angiogram.

How long will it take?

The procedure is very quick and should be completed within 60 minutes.

What preparation is there my angiogram?

Before the procedure you will need to fast (not eat or drink). If you’re appointment is in the morning, we will ask you not to eat or drink from midnight on the day of your appointment.

If you require a small drink, water is permitted up to 2 hours before your appointment. However, eating and drinking on the day of your appointment can cause delays and even cancellations.

If you are taking regular medication these should be taken as with a small amount of water, unless it has been specified in your appointment letter. Please bring a list of your current medication with you.

You will need to attend to the area specified on your admissions letter on the day of your appointment. On admission a member of staff will take clinical observations, such as measuring your blood pressure and completing a safety checklist.

At this time a small blood test may be performed. It is important that you tell the staff of any allergies you may have, as well as mentioning if you have diabetes, asthma or any heart problems,
 
If you are female the staff may also require to check if you could be pregnant.

The interventional neuroradiologist performing the procedure will visit you to explain the benefits of the procedure and any associated risks.

They will then ask you to sign a consent form, and answer any questions that you may have about the procedure.

Before you are taken to the angiography department you will be asked to change into a hospital gown and remove any jewellery or hair pieces that you are wearing.

It advisable not to bring valuables into the department for your procedure.

What happens during my procedure?

Once you arrive in the angiography suite an anaesthetist will insert a cannula into a vein in your arm.

This is completed so that if you require any medication or fluids during your procedure, it can be easily given. This can also be used to administer sedation for patients for patients who are very anxious, however, most patients are easily able to complete the procedure without any medication.

You will then be taken into the angiography room. This is a large, specialised theatre that contains two x-ray machines. You will be asked to lie on an x-ray table and two machines will be moved into position over you.

These machines are necessary to help the doctor carefully guide the catheters into the correct positions.
 
To ensure that the procedure is kept sterile your groin will be cleaned with a sterile solution and you will be covered with sterile covers. This will reduce the chance of any infections.

The Interventional Neuroradiologist will then inject local anaesthetic into the groin which will numb the area where the artery is located.

When the area is numb a sheath (a short thin tube) will be inserted into the artery in your groin. This should not be painful, but you may feel some pressure whilst it is being correctly placed.

After this a catheter will be placed through the sheath and guided through the arteries until it reaches the correct area. You will not be able to feel the catheter being moved through your arteries.

Contrast dye is then injected through the catheter whilst the x- ray machines collect images.

The radiologist may ask you to hold your breath and keep very still whilst the images are being collected. This limits the chance of any images being blurred.

The x-ray machine will then move around you, allowing for the arteries to be looked at in different angles. When the dye is injected, some patients may feel a warm flush, experience a metallic taste or some visual symptoms (flashing lights).

Once all the images have been collected the Interventional Neuroradiologist will remove the catheter and sheath from the artery within your groin.

It is then necessary to firmly press over the entry site for at least 10 minutes, which will prevent bleeding.

What happens after the procedure?

When you are on the ward it is important to rest. You will be asked to lie flat for between 4 and 6 hours, to ensure the entry site has sufficiently healed.

During this time, you will have regular clinical observations performed, and will be allowed to eat and drink as normal. When the ward staff are happy you will be able to go home.

You should be accompanied home by a responsible adult and must not drive for 24 hours.

Public transport is not recommended in case you feel unwell. If you require hospital transport, please the appointments office.

It is recommended that you have an adult stay with you for the 24 hours after your procedure.

It is also advisable to avoid strenuous exercise for 48 hours and do not have a bath or shower for 12 hours after your angiogram.

Simple painkillers can be useful for post angiogram discomfort, and regular medications should be taken as normal unless stated otherwise by hospital staff.

It can be beneficial to drink additional fluids to help remove the contrast dye from your body.

You should contact a doctor if you experience any of the following after your angiogram.

• If your groin begins to bleed. In this case you try and apply pressure to the area whilst you are awaiting advice
• If your groin becomes very sore or swollen
• If you have any new symptoms following your angiogram.

When will I get the results?

Although the Interventional Neuroradiologist will look at the images whilst they are being acquired, they must be examined in detail after your angiogram.

These images may then be discussed with your referring consultant and a formal clinic appointment will be arranged to discuss the results and any further recommended treatment.

Are there any potential risks?

Catheter angiograms are very safe and performed on a regular basis by the Angiography team.

• Allergic reaction

Occasionally some patients have an allergic reaction to contrast dye. This is normally minor and would result in a skin rash or nausea.

The team looking after you are trained to detect any reactions, but it is vital that any allergies are noted by the medical professionals looking after your care

• Kidney Function

Contrast can affect the kidneys due to the way it is broken down within the body. If you have poor renal function the doctor may prescribe some fluids and a blood test, which will help monitor your kidney’s function

• Bleeding/Bruising

As the procedure involves making a small puncture to the artery, there is normally a small amount of bruising to the site.
Occasionally the bleeding around the site may continue if this occurs further treatment may be required

• Infection

There is minimal chance of infection, as the procedure is completed in sterile conditions. If an infection around the site did occur, antibiotics would be prescribed.

• Further complications

Serious complications such as stroke and death can occur, but are extremely rare. These complications will all be discussed with the Interventional Neuroradiologist before you complete your angiogram.

What if I decide not to have the procedure done?

If you decide not to go ahead with your catheter angiogram after you have discussed the procedure with the radiologist, the department will notify your referring consultant.

From here the referring consultant can discuss any further options for imaging or treatment with you.

If you are diabetic

If you are diabetic please contact the Diabetes centre – between 08.30am – 12 noon
Telephone: 0161 212 2095

Do this as soon as you receive this appointment and ask to speak to a diabetes specialist nurse.

Failure to follow this advice may result in your appointment being cancelled.

Could you be pregnant?

If there is any chance you could be pregnant, please call 0161 2065091 if your appointment is at Salford Royal Hospital. Please call 0161 656 1178 if your appointment is at Royal Oldham Hospital.

Is x-ray guidance dangerous?

All x-ray machines use potentially harmful x-rays. Modern equipment is designed to keep the dose you receive as low as possible. If your doctor has asked for this test, they will have decided that the benefits from the procedure outweigh the risks from the very small dose of radiation that you receive.

What if I cannot attend my appointment?

If you have any queries about your appointment or cannot attend, then please telephone the booking office on:
0161 204 2044/2404 (Salford Royal Hospital)
0161 624 0420 (Royal Oldham Hospital)
Monday to Friday 8.30am to 4.00pm.

You can also email:
salford.radiology.booking@nca.nhs.uk (Salford Royal Hospital)
bookingandscheduling.outpatients@nca.nhs.uk (Royal Oldham Hospital)
Please include name, date of birth, address and hospital number (if known) in any correspondence.

I need an ambulance. How do I arrange one?

If you need an ambulance there are contact details on your appointment letter.

Please contact us if you are arriving by ambulance so we can time your appointment with your ambulance arrival. If we are not aware that you are coming by ambulance you may miss your appointment and it may have to be rebooked.

If you need an interpreter

If you need an interpreter for your examination, please call the department so that we can try and arrange this.

Contact Details

We hope your questions have been answered by this leaflet.

If you require help or any other information regarding your appointment you can contact: -

The Angiography Department, Salford Royal Hospital
Tel: 0161 206 2206/5091

Interventional Radiology, Royal Oldham Hospital
Tel: 0161 656 1178

Other sources of information

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, before you sign the consent form.

Further information regarding the examination can be found on the internet:

NHSUK, 13/01/2017, NHS Choices, Angiography
Website: www.nhs.uk/choices/angiography/

Brain and Spine Foundations, 03/2017, Angiogram of the Brain
Website: www.brainandspine.org.uk/angiogram-brain

Society of Interventional Radiology, 2017, Tiny incision, big result
Website: www.sirweb.org

Finally….

Hopefully some of the questions should have been answered by this leaflet but remember that 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 in advance.