Test Overview

An angiogram of the head and neck is an
X-ray test that uses a special dye and camera (fluoroscopy) to take pictures of the blood flow in the blood vessels of the head and neck. An angiogram of the neck (carotid
angiogram) can be used to look at the large arteries in the neck that lead to
the brain. An angiogram of the head (cerebral angiogram) can be used to look at
the veins or the four arteries (four-vessel study) carrying blood to the
brain.

During an angiogram, a thin, soft tube called a catheter is
placed into a blood vessel in the groin or just above
the elbow. The catheter is guided to the head and
neck area. Then an iodine dye (contrast material) is injected into the
vessel to make the area show clearly on the X-ray pictures. The angiogram
pictures can be made into regular X-ray films or stored as digital pictures in
a computer.

An angiogram can find a bulge in a blood vessel (aneurysm). It can also show narrowing or a blockage in
a blood vessel that slows or stops blood flow. An abnormal pattern of blood
vessels (arteriovenous [AV] malformation) or abnormal vessels near a tumor can
be seen.

A
magnetic resonance angiogram (MRA) or
computed tomography angiogram (CTA) may be an option
instead of a standard angiogram. Each of these tests is less invasive than an
angiogram. Some MRA tests and all CTA tests require an injection of dye. A CTA
also involves radiation exposure.

Why It Is Done

An angiogram of the head or neck is
done to:

  • Look for blockage or narrowing of the arteries
    in the neck that carry blood to the brain. The test may help your doctor decide if a procedure is needed to open a narrowed or blocked artery to increase blood flow. Blood flow to the brain that is
    slowed or stopped increases the chance of having a
    stroke or a
    transient ischemic attack (TIA).
  • Study symptoms that might mean
    problems with the blood flow to the brain. Symptoms may include severe
    headaches, memory loss, slurred speech, dizziness, blurred or double vision,
    weakness or numbness, or loss of coordination or balance.
  • Detect an aneurysm in the brain or in a blood vessel leading to
    the brain. The test may help your doctor decide if a procedure is needed to repair the aneurysm.
  • Check the pattern of blood
    flow to a tumor. This can show if the tumor has spread and can help guide
    treatment.

How To Prepare

Before an angiogram, tell your doctor
if you:

  • Are or might be pregnant.
  • Are
    breastfeeding. Use formula (throw out your breast milk) for 1 to 2 days after
    the angiogram until the dye has passed from your body. This generally takes 24
    hours.
  • Are allergic to iodine dye used in the
    test.
  • Have ever had a serious allergic reaction (anaphylaxis) from any substance, such as the venom
    from a bee sting or from eating shellfish.
  • Have
    asthma.
  • Are allergic to any
    medicines.
  • Have any bleeding problems or are taking blood-thinning
    medicines.
  • Have a history of kidney problems or
    diabetes, especially if you take metformin (such as
    Glucophage) to control your diabetes. The dye used during an angiogram can
    cause kidney damage in people who have poor kidney function.

Do not eat or drink for 4 to 8 hours before the angiogram.
You may be asked to not take aspirin, aspirin products, or blood thinners for
several days before the test and for 1 day after the test. If you take these
medicines, talk with your doctor.

An angiogram can be done as an
inpatient or outpatient. If you are an outpatient, you will stay in a recovery
room for several hours before you go home. You may want to bring something to
do or read to pass the time. Arrange to have someone take you home because you
may get a
sedative before the test. If you stay overnight in the
hospital, you will likely go home the next day.

The test may take
several hours, so you will empty your bladder just before it begins.

Also before the angiogram you may have other blood tests, such as blood
clotting (coagulation) studies, blood urea nitrogen (BUN), and
creatinine.

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to
your doctor about any concerns you have regarding the need for the test, its
risks, how it will be done, or what the results will mean. To help you
understand the importance of this test, fill out the
medical test information form (What is a PDF document?).

How It Is Done

An angiogram can be done by different types of doctors, including a
radiologist, cardiologist, or surgeon. Your doctor may be helped by a radiology technologist or a nurse.

You will need to
take off any jewelry. You may need to take off all or most of your clothes. You
will be given a gown to wear during the test.

During the test

You will likely have
an
intravenous (IV) line in a vein in your arm so your
doctor can give you medicine or fluids if needed. A device called a pulse
oximeter, which measures oxygen levels in your blood, may be clipped to your
finger or ear. Small pads (electrodes) are placed on your arms, chest, or legs
to record your heart rate and rhythm.

You will lie on your back on
an X-ray table. Ask for a pad or blanket to make yourself comfortable. A strap,
tape, or sandbags may be used to hold your body still. A lead apron may be
placed under your genital and pelvic areas to protect them from X-ray
exposure.

A round cylinder or rectangular box that takes the
pictures during fluoroscopy will be moved above you. The fluoroscope will move
under you during the test.

The place where the catheter will be
inserted (in the groin or above the elbow) will be shaved and cleaned. Your
doctor will numb the area with a
local anesthetic. Then he or she will put a needle
into the blood vessel. A guide wire will be put through the needle into the
blood vessel and the needle will be removed. The catheter then will be placed
over the guide wire and moved into the blood vessel. The catheter will be
guided through the blood vessels until the tip is in the area to be studied.
Your doctor will use the fluoroscope to watch the movement of the catheter in
the blood vessels.

When the catheter is in place, the dye is
injected through it. You may be asked to take a breath and hold it for several
seconds. Several X-ray pictures will be taken one after another. These will be
available right away for your doctor to look at. You need to lie very still so
the pictures are clear. More pictures may be taken.

An angiogram takes 1 to 3 hours.

After the test

The
catheter is taken out after the angiogram, and pressure is put on the needle
site for 10 to 15 minutes to stop any bleeding. A bandage or compression device is put on the site. This will prevent bleeding. You will be
given pain medicine if you need it.

If the catheter was put in your groin, you will need to lie still and keep your leg straight for several hours. The nurse may put a weighted bag on your leg to keep it still. If the catheter was put in your arm, you may be able to sit up and get out of bed right away. But you will need to keep your arm still for at least 1 hour.

Your doctor will give you specific
instructions after the test. You can use an ice pack on the needle site to
relieve pain and swelling.

The place in your hands and feet where
your heartbeat (peripheral pulse) can be felt may be marked with a pen. Your
pulse may be checked before and after the angiogram.

How It Feels

You may feel a brief sting or pinch from
the numbing medicine. Most people do not have pain when the catheter is in the
blood vessel.

You may feel pressure in the blood vessel as the
catheter is moved. Let your doctor know if you are having pain.

You will probably feel some warmth when the dye is put in. This feeling
lasts only a few seconds. For some people, the feeling of heat is strong and
for others it is very mild.

You may have a headache, flushing of
the face, or a salty or metallic taste in your mouth after the dye is used.
These feelings do not last long. Some people may feel sick to their stomachs or
may vomit, but this is not common.

After the test, you may have
some tenderness and bruising at the site where the catheter was
inserted.

You can drink extra fluids to pass the dye from your
body unless your doctor has told you not to.

Risks

The chance of any major problem from an
angiogram is very small, but some problems can occur. In most cases, the
problems occur within 2 hours after the test when you are in the recovery room.
If the problem occurs during the angiogram, the test may not be completed. You
may need urgent treatment that could include surgery.

  • There is a chance for an
    allergic reaction to the iodine dye. The reaction can
    be mild (itching, rash) or severe (trouble breathing or sudden shock). Most
    reactions can be treated with medicines. Be sure to tell your doctor if you
    have
    hay fever,
    asthma, or iodine allergy or food
    allergies.
  • There is a small chance that the catheter may damage a
    blood vessel or dislodge a piece of clotted blood or fat from the vessel wall.
    The clot or fat can block blood flow to the brain, arm, leg, or intestine
    (bowel).
  • Bleeding from the needle site may occur. Also, a blood
    clot can form where the catheter was inserted. This may cause some blockage of
    the blood flow in the arm or leg.
  • The iodine dye used for the test can cause water loss or direct
    damage to the kidneys. This is a special concern for people who have kidney
    problems,
    diabetes, or who are
    dehydrated. Special measures are used during the test
    to prevent problems for people who need an angiogram and have these
    conditions.
  • There is always a small chance of damage to cells or
    tissue from being exposed to any radiation, even the low level used for this
    test.

Results

Angiogram of the head and neck is an
X-ray test that uses a special dye and camera (fluoroscopy) to take pictures of the blood flow in the
blood vessels of the head and neck. Your doctor may tell you some results right
after the test. Full results are usually ready the same day.

Angiogram of the head and neck

Normal:

The blood vessels are normal
in size, shape, location, and number.

The dye flows evenly through
the blood vessels.

No narrowing, blockage,
bulging, or other problem of the blood vessels is seen.

Abnormal:

A narrow spot in an artery
may mean that a fat deposit, calcium deposit, or clot is reducing blood
flow through the blood vessel.

Blood vessels that are not in
their normal position may mean that a tumor or other growth is pushing
against them.

A bulge in a blood vessel may
point to a weakness in the blood vessel wall (aneurysm).

An abnormal pattern of blood
vessels may mean that a tumor is present.

Dye that leaks out of a blood vessel may mean that
there is a hole in the blood vessel.

There is abnormal branching of
blood vessels present since birth (congenital).

What Affects the Test

Reasons you may not be able to
have the test or why the results may not be helpful include:

  • Being pregnant. An angiogram is not usually
    done during pregnancy because the radiation could damage the developing baby
    (fetus).
  • Blockage or curving of the blood
    vessels caused by
    atherosclerosis,
    high blood pressure, or aging. This may make it hard
    to guide the catheter through the blood vessels or hard to inject the
    dye.
  • Not being able to lie still during the test.

What To Think About

  • A magnetic resonance angiogram (MRA) or
    computed tomography angiogram (CTA) may be an option instead of an angiogram.
    Each of these tests is less invasive than a standard angiogram. Some MRA tests
    and all CTA tests require an injection of dye. A CTA also involves radiation
    exposure. Some surgeons may want results
    from a standard angiogram before doing surgery to repair a damaged or abnormal
    blood vessel.

  • For people with kidney problems,
    diabetes, or
    dehydration, steps are taken to prevent kidney damage.
    Less dye may be used or more fluids may be given before, during, and after the
    test. If you have a history of kidney problems, other blood tests (creatinine,
    blood urea nitrogen) may be done before an angiogram to make sure that your
    kidneys are working well.

  • In rare cases, surgery may be needed to repair a hole in the
    blood vessel where the catheter was placed. There is also a substance that can be used to help plug the hole in the vessel and stop the
    bleeding. The substance used to plug the hole in the vessel is normally
    absorbed by the body over several months.
  • Other angiogram tests can
    be done, including:

    • A four-vessel study. The catheter is placed
      in each of the four arteries carrying blood to the head and neck (two carotid
      arteries and two vertebral arteries).
    • An arch study. The catheter
      is pulled back from the head and neck area until the tip is at the large artery
      (aorta) where it leaves the heart. This study lets your doctor check the
      arteries where they branch off the aorta.

References

Other Works Consulted

  • Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
  • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
  • Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.

Credits

ByHealthwise Staff
Primary Medical Reviewer Rakesh K. Pai, MD, FACC – Cardiology, Electrophysiology
E. Gregory Thompson, MD – Internal Medicine
Martin J. Gabica, MD – Family Medicine
Adam Husney, MD – Family Medicine
Elizabeth T. Russo, MD – Internal Medicine
Specialist Medical Reviewer Howard Schaff, MD – Diagnostic Radiology

Current as ofMay 15, 2017