Catheter cerebral angiography is a minimally invasive test that may be used to identify strokes, bleeding aneurysms and arteriovenous malformations (AVMs), as well as to differentiate embolism from large artery thrombosis or dissection. It is also helpful in diagnosis of rarer causes of stroke such as vasculitis (autoimmune inflammation of the arteries).

How a catheter cerebral angiography works

A thin plastic tube (catheter) is inserted into a peripheral artery (either at the groin or wrist) using image guidance (ultrasound and fluoroscopy). The catheter is guided selectively into the different neck arteries that are being evaluated. Pictures of the arteries and their branches are taken during injection of X-ray (iodine-based) contrast (similar to the CT scan dye) into the artery.

Using X-rays, images are taken as the dye works its way through the cerebral circulation and the catheter is navigated to the area being examined. This can produce clear, very detailed pictures of blood vessels in the brain and may eliminate the need for surgery.

Catheter angiography is less commonly used in the acute evaluation of ischemic stroke, but is commonly used in the setting of hemorrhagic stroke. In ischemic stroke, it is used in treatment for re-opening the blocked vessel causing the stroke.

The test itself is associated with a small (0.5%) risk of stroke, and patients may be allergic to the contrast dye, which has rarely been associated with the development of renal failure, particularly when preexisting kidney disease and diabetes are present.