Angiogram - Cerebral

Your Consultant has requested for you to have a Cerebral Angiogram.  This is carried out in the X-Ray Department by a Radiologist, Radiographers and Nurses.

What is a Cerebral Angiogram?

A Cerebral Angiogram is an x-ray procedure of the brain which gives highly detailed  information about the brain’s blood vessels and the flow of blood through the brain. A clear fluid (contrast agent) which is opaque to x-rays is injected and allows the blood vessels to be seen on x-ray. The procedure can be used to help diagnose or investigate a number of problems affecting the blood vessels, including:

• a brain aneurysm (a bulge in a blood vessel in your brain)
• a brain arteriovenous malformation (abnormal tangle of blood vessels)
• Follow-up of previous treatment
• To plan further treatment
• atherosclerosis (narrowing of the arteries)

Preparation Required Prior To Your Cerebral Angiogram

Unless there is a medical reason not to, you should aim to drink 2 litres of water or juice the day before your angiogram unless instructed otherwise. This helps prepare your kidneys to flush the dye out.

 

If your angiogram is as an outpatient:

You will be requested to arrive on the ward for 07.45am.  You may have a light breakfast.  You do not need to fast for this procedure.  Please also bring a dressing gown and slippers.

On admission to the ward you will have all your details taken by a Nurse and your blood pressure and pulse recorded.  A Doctor will take medical details.

Please state if you have any allergies or if you have had any previous reactions to x-ray dye.

Once the Doctor has explained the procedure and any related risks, you will be asked to sign a consent form.

You will be asked to change into a patient gown and given hospital underwear. You will also be given a pair of tight stockings to wear to prevent blood clots.

You will be asked to remove any jewellery or hair clips.  If you have hair extensions it may be necessary to have these removed before you attend for your appointment.

 

If your angiogram is done as an inpatient:

You will be informed by the nurse/ doctor on the ward or at your pre-operative appointment if you need to fast for your angiogram. You usually only need to fast if there are plans for you to have a general anaesthetic.

 

What happens during the procedure?

The Radiologist, assisted by the Radiographer and Scrub Nurse will introduce themselves to you. A student may also be present if you agree. The angiogram is performed in a specialised room within the x-ray department.

You will be asked to lie down on the x-ray table and you will be made as comfortable as possible.

The Nurse will expose the area at the top of the thigh (groin) if it is a femoral artery approach.  We may also approach via the radial artery in your wrist. In this case, we will expose your wrist and forearm.  The area is cleaned with sterilising solution and you will be covered with sterile sheets.

Local anaesthetic is injected into the groin or wrist to numb the area. This may sting a little at first, but will reduce any further discomfort during the angiogram.

A very thin plastic tube, called a catheter is then threaded into the blood vessel. It is gently moved into the main blood vessels that supply the head and neck. You will not feel this tube moving inside you.

The position of the tube is carefully monitored by the x-ray cameras. Once the tube is in the correct position, the dye is injected into the tube. A series of x-rays of the blood vessels are then taken.

During the injection of the dye you may experience a warm feeling, seeing stars and lights or have a strange taste. All of these are normal and only last a few seconds. Please inform the Radiologist if any of these are particularly unpleasant.

It is important that you stay very still during the angiogram in order to achieve the best possible x-ray images of the blood vessels.

 

How long will it take?

You will be in the department for approximately one hour.

 

After the procedure?

When all the x-rays have been taken the tube will be removed from your groin or wrist. If the approach has been from your groin, the Radiologist will  insert a small ‘plug’ into the area where the tube was removed and then press firmly on this area for about 5 minutes to prevent bleeding. A small dressing will be applied at the site.

If the approach is from the wrist, the Radiographer will apply a wristband which is attached to a small inflatable balloon.  This will be inflated over the puncture site and slowly deflated over time whilst you are in the hospital.  The band will be removed before you leave.

When you are taken back to the ward, you must remain lying in bed keeping the legs straight for a minimum of 2 -3 hours. This is to protect the groin site. You may have your head slightly raised up for comfort.

If you had the procedure from your wrist, you can sit in a chair and rest.

You may eat and drink. It is important that you are well hydrated after your angiogram so please ensure that you drink 2 litres of fluids in the 24 hours after your appointment.

The nursing staff will carry out regular observations. This includes checking the injection site in your groin for any signs of bleeding, excessive bruising or swelling. It is normal to have a little bruising around the groin/wrist area and the area may feel uncomfortable. Most people have little or no after effects.

Your condition will be assessed by the Nurses and a decision will be made about when you can be discharged from the hospital on the same day.

 

Please make arrangements for someone to collect you from the hospital and take you home by car, as we advise not to use public transport. You are not permitted to drive for 24 hours post procedure and we would like someone to stay with you at home in the first 24 hours. Please inform the department if this is not possible, as we will need to identify alternative arrangements.

 

Are there any side effects/risks or complications?

Serious side effects are rare; however you need to be aware that the following can occur:

Bleeding: at the site of the tube insertion after the procedure.  Delayed bleeding is uncommon in your groin/wrist, but it is the major reason you will be observed after the angiogram is completed.  Rarely the underlying artery can be damaged during the procedure.  This would require urgent surgery and possibly a blood transfusion.

Stroke: This is the most significant risk of having an angiogram.  The chance of developing a permanent stroke (weakness, numbness or paralysis) as the result of an angiogram is approximately 1 in 1000 people.

Allergic reaction to the local anaesthetic or x-ray dye used:  this can vary from slight to life threatening, though this is very rare.

 

Care of the puncture site at the groin/wrist after your angiogram.

Please see separate information leaflet with regards to aftercare.

 

Please contact the X-Ray Department prior to the procedure if:

 

• There is any chance you could be pregnant due to the use of X-rays during

           this procedure.

• you are on blood-thinning medication such as Warfarin (Coumadin),

           Ticlopidine (Ticlid), Apixaban (Eliquis), Dabigatran (Pradaxa) and

           Rivaroxaban (Xarelyo).  These will need to be stopped safely for a period of

           time before the procedure.

• If you have any drug allergies or any other allergies.
• You have been diagnosed with a heart condition or kidney problems

 

Results

Your Consultant has decided that this would be an appropriate procedure for you to have and if you are not happy to proceed then we can refer you back to them.

The results are sent by the Radiologist to the Doctor who referred you for the procedure. They will discuss the results and plan any further treatment if required, with you at a clinic appointment within 4-6 weeks.

 

If you feel unwell when you return home, please contact your GP or call NHS Direct on 111.

  

ADVICE FOR CARING FOR PUNCTURE SITE TO GROIN/WRIST POST OPERATIVELY.

If the problem is considered serious, help should be sought from your local accident and emergency department immediately. Otherwise, you should contact your G.P., NHS direct or visit your local walk in centre.

 

• Do not strain or lift anything greater than 10lb for 10 days following angiogram
• Drink plenty of water or juice 24 hours before and 24 hours after the angiogram to prepare the kidneys and flush the dye from your body (about 2 litres or 10 glasses)
• Do not drive or operate machinery for 24 hours following angiogram
• Do not do any physical exercise or sexual activity for 24 hours following the angiogram.
• Keep the dressing on, clean and dry for 24 hours following the angiogram
• After 24 hours the dressing can be removed and a shower (not bath) can be taken. A bath and swimming is allowed once the site is fully healed.
• Clean and inspect the site and wash with mild soap and water. Dry and re-cover with a plaster until it is healed completely
• Report to A+E if the site bleeds and not stopped after 15 minutes of firm (but not excessive) manual pressure.
• Report to your doctor/ us/ A+E depending on the severity if there is any swelling; change in colour (paler or darker); change in temperature or change in sensation to the leg/hand.
• Report to your doctor if there are any signs of infection such as redness, pain, swelling or pus from the site.
• Report to your doctor/ us/ A+E depending on severity if there are signs of excessive new bruising (a small amount of bruising is expected from the procedure).
• If you have a new lump in at the site of the angiogram puncture which pulsates you should cover it- do not mobilise and must have it seen to urgently: either go to A+E or inform us
• If you have had a puncture in the groin and develop pain in the abdomen (flank) on the side of the angiogram you must attend A+E or speak to us urgently

• Rarely people can get serious complications following an angiogram which may need further expert management including urgent surgery and so if you are unsure, you should always let someone know if you think that the puncture site isn’t as expected

Although rare you should report to your  A+E department if you have any new stroke like symptoms or severe headache.

Contact details for verbal advice following angiogram;-

 

Verbal advice is available 24 hours a day / 7 days a week.

During the day, this can be through the ward you were on after your angiogram.

 

At night you should call 0151 529 5639 and ask to be put through to a member of the SMART team.

 

For any emergency see your G.P or your go to your local Accident and Emergency Department

 

Patient Experience Team provides a PALS service. 0151 529 6100

 

Neurovascular Nurse Specialists:  0151 556 3325

Or through hospital switch.

(Non-urgent enquiries – calls may not be answered the same day)

 

Walton Centre switchboard - 0151 525 3611

 

Dott Ward -0151 529 5633 / 5634

 

Cairns Ward - 0151 529 5637 / 5638

 

Caton Ward -0151 529 5628 / 5629

 

Sherrington Ward - 0151 529 5641 / 5642

 

Chavasse ward -  0151 529 5070

 

Lipton Ward - 0151 529 8884 / 8738

 

High dependency - 0151 529 5489/ Intensive Care - 0151 529 5772/ 5773