Cerebral Angiography

What is cerebral angiography?

Catheter cerebral angiography is the gold standard for evaluating brain arteries and veins. Through a thin catheter inserted in a peripheral artery (femoral or radial), iodinated contrast is injected directly into cerebral vessels, generating high-resolution, real-time X-ray images of cerebral blood flow.

No other exam offers the same spatial and temporal resolution for evaluating cerebral circulation. Angiography can identify vascular lesions that other exams (CT angiography, MR angiography) may not detect or adequately characterize.

Indications

• Cerebral aneurysms — detection, characterization, and treatment planning
• Arteriovenous malformations (AVMs) — complete mapping of feeding arteries, nidus, and venous drainage
• Dural arteriovenous fistulas — definitive diagnosis and classification
• Arterial stenoses — precise quantification of carotid or intracranial stenosis
• CNS vasculitis — evaluation of diffuse vascular irregularities
• Post-SAH vasospasm — diagnosis and possible same-session treatment
• Hypervascular brain tumors — vascularization assessment before embolization or surgery
• Cerebral hemorrhage of unknown cause — when other exams fail to identify the bleeding source

Technology: Digital Subtraction Angiography (DSA)

Digital subtraction is the technique that makes cerebral angiography so powerful. A “mask” image is captured before contrast injection. When contrast is injected, subsequent images are subtracted from the mask, eliminating bones and soft tissues and showing only blood vessels with millimetric definition. Additionally, 3D rotational angiography enables three-dimensional vessel reconstructions for detailed planning of endovascular procedures.

Risks and safety

Diagnostic cerebral angiography is a safe exam when performed by an experienced specialist. The rate of permanent neurological complications is below 0.1%. Risks include puncture site hematoma (most common, usually mild), contrast allergic reaction (rare, preventable with preparation in known allergic patients), and transient vascular injury (very rare).

Recovery

After the exam, the patient rests for 4-6 hours with a compressive dressing at the puncture site. Most patients are discharged the same day (outpatient angiography) or the next day. Intense physical exertion should be avoided for the first 48 hours, and good hydration is recommended to aid contrast elimination by the kidneys.

If your doctor has ordered a cerebral angiography or you have a cerebrovascular condition requiring investigation, schedule a consultation for assessment and exam planning.