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Clinical Instructions

BMC Cerebrovascular and Stroke Center offers a wide variety of tests to diagnose your condition. View this section for a list of test instructions prior to your appointment. You will be able to download and print these instructions from your computer. If you do not see your test, please contact your office location for instructions.

Before your procedure, your physician will give you instructions concerning food and liquids. It is very important that you follow these directions, so the surgery or procedure may proceed as planned.

Cerebral, Head or Neck Angiogram

  • Go home and rest quietly for the remainder of the day. DO NOT drive or make legal decisions today. You may resume normal activities tomorrow.
  • You must have a responsible adult drive you home.
  • You may resume your normal diet after the procedure. Drink extra fluids today (6 to 8 glasses), unless otherwise instructed by your physician. This will encourage the excretion of the contrast material. Avoid alcoholic beverages and depressant drugs for 24 hours.
  • If you develop bleeding at the site, lie flat and put direct pressure on the site for 15 minutes. You may also put an ice pack at the entry site at the time you apply pressure. If the bleeding persists, reapply pressure. Call 911 and have the ambulance take you to the closest Emergency Department.
  • You may have a lump the size of an olive or peanut shell under your skin at the insertion site. Some skin discoloration and mild tenderness at the insertion site is normal. Bruising will gradually fade within 1-2 weeks. If bruising increases in size or swells, you should notify your physician's office.
  • DO NOT smoke for 24 hours after the procedure or preferably, indefinitely.
  • We will call you to schedule a follow-up appointment. We will notify your referring physician with your results.
  • If you have any questions or concerns please call 617.638.6595 from 7:30 am to 5:30 pm Monday-Friday. If you cannot reach your physician in an emergency, go to the hospital closest to your home.

Embolization

What Is Embolization?

Embolization is a procedure in which a device or material is placed through a catheter (see angiography) into an abnormal artery in order to block it off.

When Should I Have An Embolization Procedure?

Embolization is useful in selected medical conditions after complete evaluation of the medical problem by a team of specialists. Embolization techniques can help stop serious bleeding and prevent bleeding during surgery on highly vascular head and neck tumors. Embolization may also be used as the primary treatment of certain conditions, such as arteriovenous malformations, arteriovenous fistulae, and aneurysms.

Is It Safe? Will It Hurt?

Embolization, when performed for appropriate indications by radiologists with training and experience, is a safe technique. Possible complications and side effects vary depending upon the nature and location of the condition to be embolized. These will be explained to you in detail before you give permission for the procedure. The process of catheterization results in some discomfort, similar to a bruise, at the catheter entry site. In addition, there maybe discomfort in the embolized area for up to one week following the procedure. This will be controlled with medications.

How Should I Prepare For The Procedure?

You will be given written instructions at the time the procedure is scheduled. In general, the patient must eat no solid foods nor clear liquids for 6 hours prior to the procedure.

What Will Happen During The Procedure?

The initial part of the procedure will be conducted in a similar fashion to diagnostic angiography. An intravenous line is placed in the patient's hand or arm and medication is given to make the patient comfortable or to induce general anesthesia. A catheter is placed, usually through the artery at the crease of the hip, into the appropriate blood vessel, and an angiogram is performed by injecting contrast medium into the blood vessel and obtaining a series of x-ray images. After determining the precise blood vessels that need to be embolized, the radiologist advances the catheter into the exact position required and delivers the blocking agent or material into that blood vessel through the catheter. Contrast injection is repeated to confirm that embolization has had the desired effect, and then the catheter is removed. The patient is transferred to the Recovery Room/Short Stay Unit and asked to lie with the affected leg still for 4 to 6 hours. The patient is monitored frequently during the recovery period.

How Does This Technique Work? What Does The Radiologist See?

The angiogram performed prior to embolization shows the radiologist which blood vessels are abnormal and need to be blocked. Once the appropriate device or material has been placed into the blood vessel, the abnormal blood flow to tissues is stopped and diminished. In the case of a temporary condition, such as bleeding, the radiologist may use a material that only temporarily stops the blood flow, so the blood vessels can reopen and resume normal blood flow at a later time. In conditions where the embolization is being used as a primary treatment for a condition, other materials and devices are available to produce permanent blockage of the abnormal blood vessels. Because some of these conditions have the ability to induce the formation of new blood vessels, embolization may have to be performed in stages or more than one session.

How Will I Learn The Results?

The neurointerventionalist who performs the procedure will discuss the immediate findings and results with you after the procedure is completed.

What If I Have Other Questions?

To obtain additional information before or after embolization, contact 617.638.6595 or 617.414.4632 (Radiology Nursing Office).

Angiography

What Is An Angiogram?

An angiogram is a type of x-ray image that precisely demonstrates the arteries and veins in a specific organ or body part. It is performed by a radiologist with subspecialty training in invasive techniques. Specialized x-ray equipment with computerized and rapid serial imaging capability is used to perform this study.

When Should I Get An Angiogram?

Since angiography is an invasive technique, it is recommended only in specific situations when precise information regarding blood vessels is required, and when this precision cannot be adequately provided by noninvasive imaging techniques such as magnetic resonance imaging, computed tomography, or ultrasound. Examples of specific conditions that are investigated by angiography include cerebral vascular disease (such as stroke, aneurysm, or hemorrhage into the brain), vascular malformations, highly vascular tumors (tumors with a large blood supply), bleeding from a variety of causes, hypertension (high blood pressure), and other symptoms that may be caused by inadequate blood supply. Diagnostic angiography is often combined with a therapeutic procedure that is performed through the same catheter (such as aneurysm coiling, embolization, carotid/intracranial stenting, or angioplasty).

Is It Safe? Will It Hurt?

Angiography, when performed by properly trained and experienced physicians, is a safe procedure with no significant long-term side effects. However, as with any other invasive procedure, complications can occur. These will be explained to you in detail before you give your consent for the procedure. The patient who is not under general anesthesia may experience mild discomfort during injection of the local anesthetic (numbing medication), which precedes the insertion of the catheter. The remainder of the examination is not painful, although the patient must lie very still during the procedure. After the angiogram is completed, there may be some mild discomfort (similar to a bruise) at the catheter site.

How Should I Prepare For The Procedure?

You will be given detailed written instructions regarding time and place of arrival and dietary preparation. In general, patients are asked not to eat solid food for 8 hours prior to the procedure and to stop drinking clear fluids 6 hours before the procedure. A neurointerventionalist will explain the procedure in detail and obtain your signed consent (permission) before the procedure.

What Will Happen During The Procedure?

Initially, an intravenous line is started in the hand or arm. Patients are given medication through this intravenous line to help them relax or go to sleep. The area where the catheter will be inserted (usually at the right hip) is washed with an iodine solution and the patient is covered with sterile drapes in order to prevent infection. Local anesthetic is injected into the skin, and once the area has been numbed, the neurointerventionalist passes a needle into the artery. The needle is then replaced with a catheter (small hollow tube) that the radiologist guides into the appropriate blood vessel to allow series of images to be taken. Once the examination is completed, the radiologist removes the catheter and applies some pressure to the catheter entry site in order to prevent bleeding. The patient is then transported to the Recovery Room/Short Stay Unit and is asked to lie still without bending the leg for 4 to 6 hours.

How Does This Technique Work? What Does The Radiologist See?

Angiographic images are made by special computerized x-ray equipment. The computer subtracts the x-ray image of the body from the x-ray of the injected contrast medium, creating an image of just the injected blood vessels. Each image shows the blood vessels in a different phase of circulation (from atrial through venous). The radiologist is then able to determine the nature and location of any abnormalities of the blood vessels, such as aneurysms, arteriovenous malformations (AVM), arteriovenous fistulas, or blood vessel stenosis or occlusions.

How Will I Learn The Results?

You will learn the results from your neurointerventionalist performing the procedure or referring physician. The results will be available to your physician immediately after the procedure, although in complex situations, it may require a few hours for the neurointerventionalist to complete the process and interpret the films.

What If I Have Other Questions?

To obtain additional information before or after the angiogram, contact 617 638 6595 or 617 414 4632.

BMC Physicians performing cerebral and spinal angiography

References

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