Cerebral angiography

Information about cerebral angiography procedures and what to expect when your child comes into Great Ormond Street Hospital (GOSH).

Cerebral angiography is a test that is carried out to study the blood vessels in the brain and neck. It is carried out in the Department of Radiology by a neuroradiologist – a doctor with specialised training in taking pictures of the brain and nervous system.

The test enables doctors to see a map of the blood vessels in the brain and neck, as well as to understand how blood flows between the different parts of the circulation. Sometimes a cerebral angiogram is carried out to enable doctors to give treatments directly into abnormal blood vessels. Your child’s doctor will discuss the precise reasons for the test with you.

You will already have received information about how to prepare your child for the procedure in your admission letter. You may need to come to GOSH before the procedure so that your child can have a pre-admission assessment to check that they are well enough. This appointment may involve taking blood samples and other tests.

Your child needs to be fasted for the procedure for the general anaesthetic. If your child takes regular medication, please speak to your child’s team about when to stop these before the procedure.

As a general rule:

Food and milk:

• Breast-fed babies- can have their last feed three hours before the procedure. Breast milk is digested faster than solid food or formula.
• Bottle-fed babies and children- can have their last milk feed, food or milk drink, six hours before the procedure. They should not have any food or milk after this time.

Water:

• All babies and children can have a drink of water (but no other fluids), until one hour before the procedure.

It is equally important to keep giving your child food and drink until those times to ensure they remain well-hydrated and get adequate nutrition. This may involve waking your child in the night to give them a drink which we recommend.

Please follow these instructions carefully, otherwise your child’s procedure may be delayed or even cancelled.

Your child will need to be admitted to a bed on a ward in the hospital. The person bringing your child to the procedure should have ‘parental responsibility’ for them. Parental responsibility refers to the individual who has legal rights, responsibilities, duties, power and authority to make decisions for a child. If the person bringing your child does not have parental responsibility, we may have to cancel the procedure.

An anaesthetist will come and talk to you about your child’s anaesthetic. The specialist performing the procedure will explain the procedure in more detail, discuss any questions you may have and ask you to sign a consent form giving permission for your child to have the angiogram. If your child has any medical problems, please tell the specialists. Contrast dye, which shows up well on X-rays is used during the procedure and is removed from the body through urination (peeing), so please tell the doctors if your child has any kidney problems.

As the procedure involves the use of X-rays, legally, we have to ask anyone over the age of 12 whether there is any chance they might be pregnant. We will also ask for the first date of their last period (if started). This is to protect babies in the womb from receiving unnecessary radiation.

You and your child will then be brought to the Interventional Radiology (IR) suite within the X-ray department for the procedure to be done.

To perform a cerebral angiogram, the neuroradiologist will:

• Insert a needle into an artery (large blood vessel) in your child’s groin. They will then place a catheter (a narrow plastic tube) into the artery.
• The catheter is then threaded through the arteries of the body and carefully put into each of the four main arteries in the neck which go on to supply the brain.
• X-rays are taken to check that the catheter is in the right place.
• Dye is then injected through the catheter. A series of X-ray pictures are taken of the blood vessels and the way that the dye flows through them.
• At the end of the test the catheter is removed from the groin.
• No stitches are necessary, as only a small mark is left, which should heal completely within a few days.

Your child will return to the ward after they have recovered from the anaesthetic. After a general anaesthetic, some children feel sick and may vomit. Your child may have a headache or a sore throat or experience some dizziness, but these side effects are usually short-lived and not severe.

When your child comes back to the ward, the nurses will check the puncture site regularly. Your child’s neurological functions will be checked regularly too. Your child will be asked to move their arms and legs and speak, and their eye response to light, pulse, blood pressure and temperature will be monitored. Your child can start eating and drinking as normal once they feel ready. It may be possible to leave the ward on the same day as the procedure.

If there are no complications directly following the procedure, your child will only need to stay in hospital for the rest of the day and then can spend a night in the patient hotel. They will usually be able to leave the ward once their vital signs are normal, the catheter site is not bleeding, and they have had something to eat and drink.

There will be a small dressing in the area, which you should keep in place and dry for at least 48 hours. We advise that your child avoids games or PE for at least five days after the procedure.

You should call the hospital if:

• The area where the catheter was inserted looks red, swollen and feels hotter than the surrounding skin.
• Your child starts bleeding from where the catheter was inserted. If this happens, apply pressure to the site of the bleeding immediately.
• Your child is not drinking any fluids after the first day back home.
• Your child is in a lot of pain and pain relief does not seem to help.
• The leg where the catheter was inserted looks or feels different to the other leg.

You can call the ward by calling the GOSH switchboard and asking for the ward your child was discharged from.

Telephone: 020 7405 9200

If you are unable to get through, please call NHS111 by dialling 111.

The pictures are analysed by a neuroradiologist who will make a report to your doctors. The results will not be available straight away and usually we will make an outpatient appointment to discuss them with you.

Cerebral angiography is performed under general anaesthetic in children, although some teenagers may choose to be awake during the test. Although every anaesthetic carries a risk, this is extremely small.

There is only a small risk of infection because no incisions or cuts are necessary. Your child may bleed from the area where the catheter is inserted, but this can be minimised by applying pressure for a few minutes after the procedure. A bruise may develop where the catheter was inserted, and some discomfort felt in this region, but pain relief like paracetamol or ibuprofen is usually enough, unless you are told otherwise by your doctor.

Rarely a clot can form in the leg artery where the catheter is inserted, or the artery can go into spasm. This may affect the circulation in the leg. If this happens it may be necessary to give medicine to thin your child’s blood for a short time.

There is a small risk that the catheter used may damage the blood vessel in the neck or that blood circulation to the brain may be affected by the dye used. This could result in neurological symptoms such as problems with movement, sensation or vision. However, these complications are rare. The chance of any symptoms like this occurring is around one per cent. If these symptoms do occur, they are temporary in most people. Your child’s doctors feel that the potential benefit of performing this test is worth this level of risk and you should discuss this with them.

The procedure does involve the use of X-rays. The levels that are used are low dose and therefore low risk. If you have any concerns regarding the use of radiation, please discuss this with the person performing your procedure beforehand.

Your child’s doctor may be able to gain information about their blood vessels using another type of imaging procedure, such as an MRI or CT scan. Usually, angiography gives more detailed pictures than other types of scans. Angiography is often just one of many tests and procedures your child will have to help the doctors make a diagnosis and is not usually undertaken unless less invasive tests cannot provide the necessary information.

If you have any questions, please speak to you child’s doctor or nurse or call Interventional Radiology:

Telephone: 020 7405 9200

You can also contact us through MyGOSH.