1.3 What is Cerebral Angiography?

Ø Angiography is a minimally invasive medical test that uses x-rays

and a contrast material to produce pictures of blood vessels in the
brain.
In cerebral angiography, a thin plastic tube called a catheter is
inserted into an artery in the arm or leg through a small
incision in the skin. Once the catheter is guided to the area being
examined, contrast material is injected through the tube and
images are captured using a small dose of ionizing radiation (x-rays).
2.) What are some common uses of the
procedure?
Ø Physicians uses the procedure to detect or confirm
abnormalities within the blood vessels in the brain,
including:
• An aneurysm.
• Atherosclerosis, a narrowing of the arteries.
• Arteriovenous malformation.
• Vasculitis.
• A tumor.
• A blood clot.
• A tear in the lining of the artery.
A cerebral angiogram may be performed:

• To evaluate arteries of the head and neck before surgery.

• To provide additional information on abnormalities seen
on MRI or CT of the head.
• To prepare for other medical treatment.
• In preparation for minimally invasive (endovascular)
treatment.
The procedure is also used to help diagnose the
cause of symptoms such as:
• Severe headaches
• Memory loss
• Slurred speech
• Dizziness
• Blurred or double vision
• Weakness or numbness
• Loss of coordination or balance
3.) How should I prepare?
ØYou should report to your doctor all medications that you are
taking including herbal supplements, and if you have any
allergies, especially to local anesthetic medications, general
anesthesia or contrast materials containing iodine (sometimes
referred to as “dye” or “x-ray dye”)
ØYour physician may advise you top stop taking aspirins,
nonsteroidal anti-inflammatory drugs (NSAIDs) or blood
thinners for a specified period of time before your procedure.
ØAlso inform your doctor about recent illnesses or other
medical conditions.
ØIf you are going to be given a sedative during the procedure,
you may be asked not to eat or drink anything for four to eight
hours before your exam. If so, you may want to have a relative
or friend accompany you and drive you home afterwards
ØYou will receive specific instructions on how to prepare,
including any changes that need to be made to your regular
schedule.
ØYou will likely be instructed not to eat or drink anything after
midnight before your procedure. Your doctor will tell you which
medications you may take in the morning
ØWomen should always inform their physicians and x-ray
technologist if there is any possibility that they are pregnant.
Many imaging test are not performed during pregnancy so as
not to expose the fetus to radiation. If x-ray is necessary,
precautions will be taken to minimize radiation exposure to
the baby.
ØIf you are breastfeeding at the time of the exam, you should
ask your radiologist how to proceed. It may help to pump
breast milk ahead of time and keep it on hand for use after
contrast material has cleared from your body, about 24 hours
after the test.
4.) What till you experience during and after the
procedure?
ØYou will feel a slight pin prick when the needle is inserted into
your vein for the intravenous line (IV) and when the local
anesthesia is injected.
ØIf the case is done with sedation, the intravenous (IV)
sedative will make you feel relaxed and sleepy. You may or
may not remain awake, depending on how deeply you are
sedated.
ØYou may also feel slight pressure when the catheter is
inserted but no serious discomfort.
ØAs the contrast material passes through you body, you may get a warm
feeling
ØYou will be asked to remain very still while the x-ray images are taken.
ØThe most difficult part of the procedure may be lying flat for several
hours.
ØYou will remain in recovery room for observation for a few hours
following the procedure before you return home.
ØIf the catheter was placed in the groin area, you should try to keep your
leg straight for eight hours. You may apply ice to the site where the
catheter was inserted to relieve pain and swelling
ØYou may resume normal diet immediately after the exam. You will be able
to resume all other normal activities eight to 12 hours after the exam
ØYou should report to your physician immediately if you
experience any of the following after your procedure:

•Weakness or numbness in the muscles of your face, arms or legs

•Slurred speech
•Vision problems
•Signs of infection at the catheter area
•Dizziness
•Chest pain
•Difficulty breathing
5.) What are the Benefits vs. Risk
Benefits

•Angiography may eliminate the need for surgery. If the

surgery remain necessary, it can be performed more
accurately.
•Cerebral angiography presents a very detailed, clear and
accurate picture of blood vessels in the brain. This is
especially helpful when a surgical procedure or other
treatment is being considered
• Results from cerebral angiography are more accurate than
others.
• Use of a catheter makes it possible to combine diagnosis and
treatment in a single procedure.
• The degree of detail display by the cerebral angiography may
not be available within any other procedure.
• No radiation remain in a patient’s body after an x-ray
examination.
• X-rays usually have no side effects in the diagnostic range.
Equipment:
Catheterization tray consist of : disposable sterile gloves, drapes, one fenestrated,
lubricant, cotton balls with container, forceps (2), prefilled 10cc syringe with sterile
water to inflate the balloon, sterile specimen container for urine sample collection.
Sterile catheter, latex (rubber) or silicone: 2 way or 3 way (where possible, select
the non-latex catheter)
Chlorhexidine 2% aqueous solution
Sterile water
Catheter
Secure device or adhesive tape
Urinary bag
Medicated lubricant (Urojet)
Note: select the smallest size catheter that is able to provide
adequate urine drainage. In general:
Size 12-14 Fr for women draining clear urine
Size 14-16 Fr for men draining clear urine
Size 16-18 Fr for patients with debris or mucous in their urine
Size in excess of 18 FR for patients with hematuria, unless
otherwise specified by physician.
Size 22 Fr for continuous bladder irrigations (CBI’s), unless
otherwise specified by physician
Types and size of catheters

Diameters:
5Fr, 6Fr, 8Fr, 10Fr, 12Fr, 14Fr, 16Fr, 18Fr, 20Fr, 22Fr, 26Fr, 28Fr
The higher the number the larger the diameter of the catheter.
1Fr. = 0.33mm (i.e. a 24Fr catheter is 8mm in diameter)
Specific considerations
Pediatric catheterization:
Size 5,6,8,10Fr or smaller depending on the size of the urethra and age
of the child.
Rarely are catheters left indwelling, typically they are intermittent and
are used to obtain sterile urine sample to rule-out infection.
In children < 2 years if age, a 5Fr feeding tube can be used if a small
diameter catheter is not available.
Using feeding tubes can cause urethral trauna
A second pair of hands for assistance is recommended for very young
children.
Male catheterization:
16Fr or 18Fr catheter is typically used for most men, as they are
more rigid and often easier to insert past the prostate.
In males it is helpful to use Urojet (syringe with lidocaine jelly ) to
minimize the discomfort with the catheterization.
Males who present with gross hematuria require 3-way Foley
catheter with the largest diameter that can be safely inserted, (22Fr,
24Fr).
• Catheters should be attached to the inner upper thigh with a
CathSecure. This will minimize discomfort and prevent the
catheter from being pulled on/out.
• When the foreskin is retracted for the purpose of
catheterization remember to return it back to its original place.
• If resistance is met while inserting the catheter, due care is
used not to damage the enlarged prostate.
• Never inflate the balloon until urine has been visualized and is
draining
Female Catheterization:
12Fr, 14Fr or 16Fr catheter is typically used.
Positioning is important to properly visualize the urethra in females.
If you are unable to visualize the urethra, raise pelvis with a pillow,
blanket or inverted bedpan.
If you catheter in the vagina leave it in place as a landmark and start
again with another sterile catheter.
Never inflate the balloon until you see urine.
If patient presents with gross hematuria a larger 3-way catheter
needs to be inserted.