What Is It?
A cerebral angiogram is a neurological test which evaluates the blood vessels that supply the brain.
Normally, on x-ray the blood vessels are relatively invisible. However, when injected with a radio-opaque dye, the blood vessels show up clearly on an x-ray. This technique is used to visualize the brain blood vessels in a cerebral angiogram but is also used in other parts of the body, such as in a coronary angiogram of the heart.
For a standard angiogram, a small catheter is placed into the blood vessels that supply the brain, the carotid arteries and the vertebral arteries. The catheter is placed through the femoral artery in the thigh and maneuvered up to the head with x-ray guidance. When the catheter is in place, dye is injected into the blood stream while x-rays are taken to allow clear visualization of the blood vessels. X-rays are taken at several time points and from several angles to visualize both the arteries and the venous system in the head.
Some centers now have 3-dimensional angiography machines that rotate around the head while the dye is injected to create a 3D model of the blood vessels. Additionally, some CT scanners have the capability of producing a 3D image of the blood vessels called a CT Angiogram. This has the advantage that no catheter is placed into the artery as the dye can be injected into the general circulation through a standard intravenous catheter (an IV).
In general a cerebral angiogram is safe, but it does have some risks. The catheter in the artery can occasionally cause injury to the artery leading either to bleeding or an arterial dissection and subsequent clotting. This can lead to stroke in rare cases. Additionally, the site of catheter insertion in the leg can be prone to hematoma formation and/or infection. These insertion site complications are generally well tolerated and easily treated in the great majority of patients.
What Is It Used For?
An angiogram is an excellent test to evaluate the blood vessels of the brain and any abnormalities or pathologies that involve them. Common examples of blood vessel abnormalities which can be demonstrated on a cerebral angiogram include cerebral aneurysm
, arteriovenous malformation
, and Moyamoya disease
Angiograms are also commonly performed to evaluate blockages of the blood vessels to the brain as in acute stroke or vasospasm.
In addition to being a diagnostic test for these various pathologies and others, some procedures are performed through the catheter while performing an angiogram. These endovascular procedures, usually performed by an interventional neuroradiologist or neurosurgeon, include coiling of aneurysms, embolization of arteriovenous malformations, angioplasty or stenting of obstructed arteries and retrieval of clots during acute stroke. In some types of brain tumors, such as meningiomas, the blood vessels supplying the tumor are embolized prior to surgical removal of the tumor.
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