Cerebral Angiography

Description

1. Following local anesthesia, a radiopaque dye is injected through a catheter in the femoral artery (or
brachial artery if femoral is inaccessible) and passed through one of the major cervical blood vessels to
assess cerebral circulation. Serial x-rays are taken after contrast dye illuminates the cerebral arterial and
venous systems. The structure and patency of cerebral arteries are examined. Contrast is cleared
through the kidneys. The test is frequently performed on an outpatient basis unless patient is already
hospitalized.

2. Three-dimensional imaging is available for more thorough evaluation of vascular abnormalities.

3. Advantages of cerebral angiography: Useful in detection of stenosis or occlusion, aneurysms, and

vessel displacement due to pathologic processes (eg, tumor, abscess, hematoma).

4. Disadvantages of cerebral angiography: Involves considerable exposure to radiation. Contraindicated

in patients with a stroke in evolution. Potential complications: temporary or permanent neurologic
deficit, including stroke, anaphylaxis, bleeding, or hematoma at the IV site, and impaired circulation in
the extremity distal to the injection site, usually the femoral artery. There is risk of contrast-induced
nephropathy.

Nursing and Patient Care Considerations

1. Omit the meal before the test, although clear liquids may be taken.

2. Evaluate for adequate renal function; should have recent normal serum creatinine.

3. Ask patient about allergies and specifically rule out presence of iodine allergy, which requires pretest
preparation. Commonly, patients with allergy to iodine also have allergies to radiopaque contrast media
that may cause severe reaction.

4. Options for pretest allergy prevention include:

a. Elective procedure: Give prednisone 50 mg orally 13, 7, and 1 hour prior to contrast and
diphenhydramine 50 mg orally 1 hour prior to contrast.

b. Urgent procedure: Give methylprednisolone IV and diphenhydramine 50 mg orally, IM or IV 1 hour

prior to contrast.

5. Mark pedal peripheral pulses.

6. Explain that a local anesthetic will be used to insert a catheter into the femoral artery (brachial artery
may be used) and threaded into the required cerebral vessel.

7. Tell the patient to expect some discomfort when the catheter is inserted into the artery. Additionally,
the sensation of a warm, flushed feeling and metallic taste should be expected when the dye is injected.

8. Caution the patient that he or she will need to lie still during the procedure and that he or she will be
asked to hold breath intermittently during scanning.
9. After angiography:

a. Maintain bed rest and do not flex lower extremities, as ordered, and monitor vital signs. Instruct the
patient to maintain bed rest for up to 6 hours. If a closing device is utilized, the time can be reduced to 2
to 3 hours.

b. Check the patient frequently for neurologic symptoms, such as motor or sensory alterations, reduced
level of consciousness (LOC), speech disturbances, dysrhythmias, or blood pressure (BP) fluctuations.

c. Evaluate renal function and monitor puncture site for bleeding, hematoma, and pulses, as ordered.
Apply pressure if bleeding or hematoma is noted and inform physician.

d. Evaluate renal function and monitor for adverse reaction to contrast medium (eg, restlessness,
respiratory distress, tachycardia, facial flushing, nausea, and vomiting).

e. Assess skin color, temperature, and peripheral pulses of the extremity distal to the IV site—change
may indicate impaired circulation due to occlusion. Inform physician, if noted.