Diagnostic Cerebral Angiography Under Conscious Sedation

During the Procedure

During a diagnostic cerebral angiogram under conscious sedation, patients can expect the following experiences:

• Pre-procedure preparation: Prior to the procedure, patients may be asked to change into a hospital gown and remove any jewelry or metal objects. An intravenous (IV) line will be placed in the patient’s arm or hand to administer medications, including sedatives and contrast dye.
• Conscious sedation: Conscious sedation involves the use of medications to help patients feel relaxed and drowsy but still responsive. Patients are typically awake and able to follow instructions but may not remember much about the procedure afterward. The sedation helps minimize anxiety and discomfort during the angiogram.
• Local anesthesia: The puncture site (either the radial access/snuffbox or femoral artery) will be numbed using a local anesthetic to minimize pain and discomfort during the procedure.
• Catheter insertion: A small needle poke is made at the access site, and a catheter is inserted into the artery. The catheter is then gently guided through the blood vessels to the area of the brain being examined.
• Contrast dye injection: Once the catheter is in place, a contrast dye is injected through it. The dye helps visualize the blood vessels in the brain, enabling the physician to identify any abnormalities such as aneurysms.
• Image acquisition: A series of X-ray images or fluoroscopy is used to capture images of the blood vessels as the contrast dye flows through them. Patients may be asked to hold their breath or change positions during the image acquisition to obtain the best possible images.
• Catheter removal and wound closure: After the necessary images have been captured, the catheter is carefully removed, and the incision site is closed, either with manual pressure or using a closure device.
• Recovery: Patients are taken to a recovery area and monitored for a few hours to ensure there are no complications. During this time, they may feel drowsy and have some discomfort at the puncture site. As previously mentioned, radial access (snuffbox) patients can typically expect to be discharged in 1-2 hours following the procedure, while femoral access patients may expect a discharge time of 2-3 hours or up to 6 hours if the closure device failed.

Throughout the procedure, the healthcare team will be present to monitor the patient’s vital signs and comfort level. Although patients may experience some discomfort, anxiety, or drowsiness, conscious sedation helps make the diagnostic cerebral angiogram a more tolerable experience.

Post-procedure care

• Patients should avoid submerging the radial (snuffbox) or femoral puncture site in water (e.g., in a bath or swimming pool) for a day until the wound is fully healed.
• A gradual return to normal activities, as tolerated and advised by the healthcare team.