A1. A Carotid Angiogram is a way of showing up blood vessels in the neck and head on a special X-ray machine. Using a fluid called ‘contrast medium’ to outline the insides of the vessels, a picture is produced, which is rather like a road map of the arteries.
A2. Your doctors have detected a problem in the blood circulation to your head. You may already have had a Doppler Ultrasound test to show the site and severity of the problem. An angiogram will show the problem area in more detail.
A3. Your doctors will have discussed your situation with the doctor responsible for performing your angiogram, the "Interventional Radiologist" (or x-ray doctor). You will have been asked to sign a consent form. You will also be given the opportunity to discuss the various types of treatment because your full and informed consent has to be given prior to treatment. If you do not want this test, the procedure will be taken no further.
A4. Printed instructions will be given to you with your appointment details. You may eat a light meal up to 2 hours prior to the procedure and drink normally. On admission to the Ward you will be asked to put on a hospital gown and your blood pressure and pulses will be checked. The Carotid Angiogram is usually done through the artery in the groin (the femoral artery).
It is very important that you inform the nursing and medical staff about all allergies and medications. If you have had reactions to contrast medium, the dye used for kidney X-Rays (IVPs) and for CT scanning, then you must also tell your doctor about this.
If you are diabetic and take insulin, you may need a drip to keep your blood sugars controlled. This will be discussed with you on the ward prior to the procedure. (see next question also and the 'Diabetic Protocol' for further information).
A6. Yes. Metformin (Glucophage, Avandamet) is most commonly taken by diabetic patients to control blood sugar, but occasionally is taken for other conditions.
If you are taking Metformin, your preparation for the procedure may change. Please ring the helpline telephone number, as above, and speak to a member of staff, who will be able to advise you.
A7. After the admission procedures on the ward, a nurse will accompany you to the x-ray Department. Here, the radiology nurse will discuss basic details of the procedure with you and the interventional radiologist will answer any further questions you may have. You will be transferred onto the x-ray table, generally flat on your back. The radiologist or nurse may place a small plastic tube into a vein in your arm, if sedation is required.
- Monitoring devices will be attached to your chest and one finger. A blood pressure cuff will be put on your arm. After the radiologist has checked the pulses in your groins, the nurse will clean the skin in this area with antiseptic fluid and cover the rest of your body with a sterile drape. Local anaesthetic (see next section) will be injected into the tissues around the artery and when the skin in this area is completely 'numb', a needle will be inserted into the artery through a tiny nick in the skin.
- A guide wire is passed through this needle and the needle is then removed. The catheter (a thin tube) can then be threaded over the wire into the artery. The catheter is then placed in the arch of the aorta (in the large artery supplying the head and neck, internal organs and arms and legs, at its highest point). An injection of contrast medium is given through the catheter and will travel through the circulation in your neck and head while the X-Ray machine records the angiogram pictures. The catheter is not placed in the arteries of the neck (carotid arteries).
A8. The initial injection of local anaesthetic may cause slight discomfort. During the angiogram pictures the contrast medium is usually injected through a special syringe pump and this may cause a warm sensation in your neck and head and give you a metallic taste in the back of your throat. This is due to the circulation of the contrast medium in your neck and head and is nothing to worry about. You may also experience some visual disturbance such as "flashing lights", but this usually disappears fairly quickly. You may also feel as if you have wet yourself, but it is unlikely that you actually have.
A9. This varies according to the complexity of the test, but you can expect to spend anything from 30 minutes up to 1 hour in the x-ray department.
A10. The radiologist will remove the catheter and press on the puncture site in your groin for around ten minutes. You will be taken back to the ward on a trolley. Nurses on the ward will carry out routine observations, such as taking your pulse and blood pressure. They will also check for bleeding or swelling in the groin. You will generally stay in bed for four hours. If the puncture site is satisfactory when you get up you may go home, if this has been agreed and arranged beforehand. You will be unable to drive yourself and a lift must be arranged. At home it is necessary for you to have someone to look after you overnight. You should rest as much as possible for the rest of the day and do not take any strenuous exercise for two days. You should however be encouraged to walk the following day.
A11. The most common complication is the development of a deep bruise called a haematoma, at the puncture site. In less than 3% of cases a blood transfusion is needed. Very rarely a small operation is required to seal the hole in the artery with a stitch. There is a small risk of stroke associated with this procedure which is less than 0.003% (less than 1 in 300 patients).
A12. You should apply firm pressure just above the puncture site in your groin for 10-15 minutes. Your partner (or the carer who has arranged to stay with you for the evening following the procedure) should telephone the hospital switchboard, (0191) 233 6161, and ask them to contact the on call surgeon at the Freeman Hospital who will then advise you.
A13. Following your examination a report will be sent to the consultant who asked for the test to be done. He/she will arrange to see you in the clinic.
A14. If you need an ambulance, you must ask your General Practitioner’s surgery to arrange one. You will need to give them three working days notice. Please inform the department if you are arriving by ambulance as we will arrange your appointment time to fit with ambulance arrivals.
A15. Should you have any suggestions or concerns, please make these known to the person conducting your examination, or by letter addressed to:
Freeman Xray Department
The Departmental Manager
Main Xray Department
Freeman Hospital, High Heaton
Newcastle upon Tyne
Tel (0191) 223 1012
Monday – Friday: 9.00am – 5.00pm
All Newcastle Hospitals Switchboard Tel: (0191) 233 6161
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Produced by: Dr J Rose, Clinical Directorate of Radiology