Cerebral & Spinal Angiography

What is cerebral angiography?

Cerebral digital subtraction angiography (DSA) is the most detailed and accurate method of imaging the blood vessels of the brain. A thin flexible tube (catheter) is passed through a small puncture in the wrist (radial) or groin (femoral) artery under X-ray guidance. Contrast dye is injected into the arteries supplying the brain, and a rapid sequence of X-ray images captures the flow of blood through the cerebral circulation in real time.

Unlike CT or MR angiography, DSA provides dynamic information — showing the timing and direction of blood flow — which is essential for the characterisation of aneurysms, AVMs, fistulas, and other vascular lesions before and after treatment.

Why might I need a cerebral angiogram?

Cerebral angiography is recommended when:

• A brain aneurysm has been identified and detailed assessment of its size, shape, and neck is required for treatment planning
• An AVM or dural fistula requires characterisation of its blood supply and drainage
• Non-invasive imaging (CTA or MRA) has been inconclusive
• Follow-up assessment is needed after coiling, stenting, or embolisation
• Pulsatile tinnitus requires vascular assessment
• Vasculitis or other inflammatory vascular conditions require investigation

The procedure

Cerebral angiography is performed in a specialist angiography suite under local anaesthesia, typically with mild sedation. Most patients remain awake throughout.

• Access — a small needle puncture is made in the wrist (radial artery) or groin (femoral artery). A short plastic tube (sheath) is placed in the artery.
• Catheterisation — a fine catheter is advanced under X-ray guidance through the aorta into each of the arteries supplying the brain in turn.
• Contrast injection — a small volume of contrast dye is injected as a series of X-ray images are acquired. You may feel a brief warm sensation during injections.
• Completion — the catheter and sheath are removed, and the puncture site is compressed or closed with a small closure device. You will be asked to rest for 2–4 hours afterwards.

The procedure typically takes 45 minutes to 1.5 hours depending on complexity. Most patients are discharged the same day or the following morning.

Risks

Cerebral angiography is a safe procedure in experienced hands, but all procedures carry some risk. The risks include:

• Minor bruising or haematoma at the access site — common and usually resolves within days
• Contrast allergy — rare; relevant allergy history is reviewed in advance
• Stroke or TIA — approximately 0.1–0.5% risk in elective diagnostic procedures; higher in complex cases
• Vessel injury — rare
• Contrast-related kidney injury — minimised by hydration; relevant in patients with pre-existing kidney disease

The risk of the procedure must always be weighed against the clinical value of the information obtained. We will discuss this with you in detail before proceeding.

MRI and CT scanning

In many situations, non-invasive imaging with CT angiography (CTA) or MR angiography (MRA) provides sufficient information without the need for catheter angiography. We review all relevant imaging before recommending further investigation and always use the least invasive approach that will provide the necessary clinical information.

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