Browsing articles in "Out of Office Procedures"

Carotid Ultrasound

What is a carotid ultrasound?

A carotid ultrasound is a noninvasive, painless screening test. Your doctor uses an ultrasound to look at the carotid arteries in your neck and see the flow of blood through them. Ultrasound, also called sonography, uses sound waves instead of X-rays to produce images of the body’s organs and tissues. A carotid ultrasound is an important test that can detect narrowing, or stenosis of the carotid arteries. Carotid artery stenosis is a major risk factor for stroke.

You have two carotid arteries, one on each side of your neck. Carotid arteries are major arteries that carry blood from your heart to your brain. A buildup of plaque can narrow or block your carotid arteries. This is called carotid artery disease, which increases your risk of stroke.

A carotid ultrasound is only one method used to screen for carotid artery disease. You should discuss different screening options with your doctor to best understand which option is right for you.

Types of carotid ultrasounds

The types of carotid ultrasounds include:

  • Doppler carotid ultrasound produces images of the flow of blood through your carotid arteries.
  • Standard carotid ultrasound produces images of the physical structure of your carotid arteries.

A carotid ultrasound typically includes both types of ultrasound.

Why is a carotid ultrasound performed?

Acarotid ultrasound is a procedurethat your doctor may recommend to diagnose or screen diseases and conditions of thecarotid arteries including:

  • Blood clot in the carotid arteries that can slow or block blood flow to the brain
  • Carotid artery dissection, which is a split in the layers of the carotid artery wall. It can slow blood flow or dangerously weaken the wall of the artery.
  • Carotid artery stenosis, which is a narrowing of the carotid arteries due to a buildup of plaque inside them. This is a major risk factor for stroke. Your doctor may suspect this condition if you have a carotid bruit (pronounced broo-E). A carotid bruit is an abnormal sound heard through a stethoscope in the carotid arteries. Other risk factors that may indicate the need for a carotid ultrasound include high blood pressure, advanced age, diabetes, high cholesterol, and a personal or family history of stroke or heart attack.
  • Congenital malformations, which are carotid artery abnormalities that are present at birth
  • Stroke and transient ischemic attack (TIA). A TIA is a group of stroke-like symptoms that generally resolve within 24 hours. However, they are warning signs that you are at risk for a severe stroke.
  • Tumors. Rarely, tumors can develop where the carotid artery branches, compressing the artery and surrounding nerves.

How is a carotid ultrasound performed?

Your carotid ultrasound will be performed in a hospital or outpatient setting by a team led by a radiologist. A radiologist is a physician who is specialized in medical imaging. A radiologic technologist often performs the carotid ultrasound. A radiologic technologist is a medical professional who is specialized in medical imaging and the care of patients during imaging procedures.

The procedure will take less than an hour and generally includes these steps:

  1. You will dress in a patient gown or wear your own loose-fitting, open-necked clothing. You will need to remove all jewelry around your neck area.
  2. You will lie on your back on a procedure table. The radiologic technologist may move or tilt the table during your exam.
  3. Your radiologic technologist will put ultrasound gel on your neck. The gel helps the ultrasound equipment make full contact with your skin by eliminating air. It also allows the equipment to slide easily across your skin without discomfort.
  4. Your radiologic technologist will then place an ultrasound transducer on your skin. The transducer is a handheld wand that sends and receives the sound waves. The radiologic technologist presses it firmly onto your skin and moves it around to see the arteries and surrounding tissues. The transducer and sound waves are painless.
  5. You may have to move or tilt your head or shoulders to get the best angle for the transducer.
  6. Once the exam is complete, your team will wipe off the gel. The gel is water-based and washes away easily.
  7. You may wait a short period of time while the radiologic technologist or radiologist verifies that the imaging is complete. Usually, you can go home immediately after the exam.

Cerebral Angiography

What is cerebral angiography?

Cerebral angiography is a procedure that allows your doctor to take a picture or image (an angiogram) of the blood vessels in your brain. Doctors use cerebral angiography to study blood vessels in your brain that are obstructed, blocked, narrowed, enlarged or malformed, and diagnose the underlying cause.

Cerebral angiography is only one method used to diagnose a variety of cerebrovascular diseases, disorders and conditions.You should discuss different screening options with your doctor or healthcare provider to best understand which option is right for you.

Types of cerebral angiography

The types of cerebral angiography procedures include:

  • Cerebral angiography is an angiographic procedure that involves inserting a catheter into a blood vessel in your groin or arm. The catheter wire is then fed, or guided to the area in the brain to be examined. X-rays are used to produce the angiogram, or picture of the vessel.  Contrast or dye is injected into the catheter to produce images of the blood vessels in your brain.
  • Noninvasive cerebral angiography uses computed tomography (CT) or magnetic resonance imaging (MRI) to produce the angiogram. MRI of blood vessels is also called magnetic resonance angiography, or MRA. CT involves X-rays but MRA does not.

A cerebral angiogram, and in some cases, noninvasive cerebral angiography, use a contrast agent, sometimes called a dye. This is given intravenously (through an IV). The contrast agent greatly improves the quality of the image produced.

Why is cerebral angiography performed?

Your doctor may recommend cerebral angiography to diagnose a variety of diseases and conditions of the blood vessels in the brain including:

  • Aneurysms, which are weakened or diseased areas of a blood vessel that become enlarged or bulge. Aneurysms can occur in the brain and other areas of the body and can lead to serious or life-threatening bleeding if they rupture or burst.
  • Atherosclerosis, or narrowing of the arteries
  • Blood clots, which may be the cause of stroke
  • Blood vessel malformations, which are usually present at birth, but may become a problem at various ages from birth to adulthood
  • Brain tumors. A doctor may order cerebral angiography to confirm a brain tumor or understand what blood vessels are connected to the tumor.
  • Cerebrovascular disease, including stroke and transient ischemic attack (TIA, a condition in which a person has temporary stroke-like symptoms)
  • Dissection or splitting of the vessels leading to the brain
  • Pre-surgery evaluation. A doctor may order cerebral angiography to evaluate the blood vessels in the head and neck before brain surgery or other invasive treatment.
  • Vasculitis, which is an inflammation of the blood vessels that can occur in the brain

How is cerebral angiography performed?

Your cerebral angiography will be performed in a hospital or outpatient setting by a neuroradiologist. A neuroradiologist is a physician who specializes in diagnosing diseases of the nervous system using radiological imaging. The neuroradiologist may lead a cerebral angiography team. Either a radiologist or a radiologic technologist will lead a noninvasive cerebral angiography team. The procedure takes from one to three hours and generally includes these steps:

  1. You will dress in a patient gown and lie on a procedure table.
  2. Your team will insert an IV to provide fluids, medications, or a contrast agent.
  3. Your team will attach devices to monitor your heart rate and blood pressure.
  4. Your team will position your head and may hold it in place with a strap or other device.
  5. For cerebral angiography:
  • Your team will take a small amount of blood for laboratory tests to verify that your kidneys are functioning properly and your blood is clotting adequately.
  • Your team may give you sedative medications through the IV to help you relax.
  • Your physician will determine the location to insert the catheter. The catheter is often placed in the artery in the groin . The area will be shaved, cleaned and numbed before a small incision is made. Your physician will insert the catheter and wire through the incision and guide it to the vessel to be examined.
  • Once the wire is in place, your team will deliver the contrast agent through the catheter and take X-rays as the contrast agent flows through your blood vessels. You may feel a sensation of warmth when the contrast agent is injected.
  • Your team will tell you when to hold still for the X-rays and may ask you to briefly hold your breath.
  • When the procedure is complete, your team will remove the IV and catheter and the catheter site will be closed.
  1. For noninvasive cerebral angiography:
  • If MRI is used, your team will give you earplugs because the machine makes loud thumping and humming noises. Closed MRI machines are long cylinders, so your team may give you a mild sedative if you are claustrophobic. The procedure table will slide into the machine for the test.
  • CT machines also have a tunnel, but it is much shorter than an MRI tunnel. The procedure table will slide into the machine for the test. Your team may ask you to briefly hold your breath during the imaging procedure.
  • If a contrast agent is used, it will be administered through your IV. You may feel a sensation of warmth when the contrast agent is injected.
  • For MRIs, it is very important for you to lie completely still during the entire procedure. Any movement may cause the images to be blurry and could result in the need to repeat the procedure. The MRI procedure takes about an hour.
  • When the procedure is complete, you may be asked to wait until the radiologist verifies that the imaging is complete. A member of the angiography team will remove your IV.

Will I feel pain?

Your comfort and relaxation is very important to both you and your care team. You may feela pinch or pin prick painduring the IV placement, but the imaging itself is painless. For catheter cerebral angiography, you should expect that sufficient pain and sedative medications will be given to you so that you stay comfortable. Sedative medications may also be given for MRI procedures if you are claustrophobic. If you are uncomfortable in any way, tell a member of your healthcare team.

What are the risks and potential complications of cerebral angiography?

Complications after cerebral angiography are uncommon. However, any procedure involves risks and the possibility of complications that may become serious in some cases. Complications can develop during the procedure or throughout your recovery. Risks and potential complications of cerebral angiography include:

  • Adverse reaction or problems related to sedation or contrast agents, such as an allergic reaction and problems with breathing
  • Bleeding or clotting problems
  • Damage to an artery from the catheter
  • Exposure to ionizing radiation, which may be harmful in excessive doses
  • Infection
  • Injury from metal objects in or on your body or in the room during an MRI
  • Kidney injury from the contrast agent, especially if you have kidney disease
  • Stroke

Reducing your risk of complications

You can reduce the risk of certain complications by:

  • Ensuring that all members of your care team are aware of any allergies you have, especially to shellfish or iodine
  • Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
  • Informing your doctor if you have any metal in your body, including screws, pins, plates, pacemakers, implants of any kind, intrauterine devices (IUDs), and bullet fragments
  • Informing your doctor if you have kidney disease or diabetes
  • Informing your doctor or technologist if you are nursing or there is any possibility that you may be pregnant
  • Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
  • Removing all jewelry and metal objects and leaving them outside the MRI room. This includes glasses, credits cards, hair accessories, and removable dental work.
  • Taking your medications exactly as directed

How do I prepare for my cerebral angiography?

You are a very important member of your own healthcare team. The steps you take before your procedure can improve your comfort level and help your doctor obtain the most accurate results. You can prepare yourself for cerebral angiography by:

  • Answering all questions about your medical history and medications you take. This includes prescribed medications, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
  • Arranging for a ride home if sedation will be used during your cerebral angiography
  • Following exactly any instructions about eating and drinking before cerebral angiography
  • Leaving jewelry, metal objects, credit cards, and other valuables at home
  • Taking or stopping medications exactly as directed. For catheter cerebral angiography, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. With certain types of contrast dyes, you should not take metformin (Glucophage) for 48 hours before and after your angiography. Your doctor will give you specific instructions about taking your medications.

Questions to ask your doctor

Preparing for cerebral angiography can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. You should feel free to contact your doctor about any questions. It is a good idea to bring a list of questions to your appointments. Common questions include:

  • Why do I need cerebral angiography? Are there any other options for diagnosing or treating my condition?
  • How long will the procedure take? When will I be able to go home?
  • What restrictions will I have after the procedure and when can I expect to return to work and other activities?
  • What restrictions will I have after the procedure and when can I expect to return to work and other activities?
  • What kind of assistance will I need at home? Will I need a ride home?
  • What medication plan should I follow before and after the procedure?
  • How will my pain or anxiety be managed?
  • When should I follow up with you? Ask for numbers to call during and after regular hours.
  • When will I receive the results of my test?
  • What other tests or procedures might I need?

What can I expect after my cerebral angiography?

Knowing what to expect after cerebral angiography can help you get back to your everyday life as soon as possible.

How will I feel after the cerebral angiography?

After the procedure, you may have mild drowsiness if you receive sedative medications. It is unlikely that you will feel pain after cerebral angiography. However, with catheter cerebral angiography, it is common to experience mild tenderness and bruising at the catheter incision site. Let a team member know if you are uncomfortable.

Your activities may be restricted following a catheter cerebral angiography. Follow your doctor’s instructions for eating, drinking and resting after cerebral angiography.

When can I go home?

You will need to stay in the outpatient facility or hospital for a short period of time after your cerebral angiography. For catheter cerebral angiography, you will likely be monitored for four to six hours after the procedure before being discharged to go home.

For noninvasive cerebral angiography, you are usually allowed to go home immediately after the procedure unless you receive sedative medications. You will be discharged home when you are fully alert, breathing effectively, and your vital signs are stable. This generally takes less than an hour, depending on the type of sedation you receive.

If you have sedation for either procedure, you will not be able to drive for about 24 hours and you will need a ride home from your procedure. Because you may still be a bit drowsy, someone should stay with you for the first 24 hours.

When should I call my doctor?

After cerebral angiography you should keep your follow-up appointments and feel free to call your physician if you have any concerns between appointments. Call your doctor if you have:

  • Bleeding
  • Chest pain
  • Difficulty walking or talking or moving a body part normally
  • Dizziness
  • Facial weakness or facial drooping
  • Fever
  • Numbness or a feeling of coolness in the arm or leg that was used to insert the catheter
  • Pain
  • Slurred speech
  • Unusual swelling
  • Vision problems