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DSA ( digital subtraction Angiography ) procedure is one of the techniques in interventional radiology to get a picture of perfusion / blood flow in the blood vessels of certain organs, by inserting a special catheter into the vessels draining the target organ then through the catheter contrast agent will be injected to visualize blood flow in the vessels under fluoroscopy monitoring. Brain DSA procedures performed by catheterization of blood vessels in the brain that on its development has transformed from not only diagnostic but also therapeutic purposes (thrombolysis) which is now introduced as a brain spa. Through a catheter that has been inserted in the DSA procedure, the doctor may also inject a thrombolytic agent (substance for blood clot destroyer) to open or improve the blood flow in the targeting area. The entire procedure is done under fluoroscopy to monitor the procedure. The doctor will keep an eye on vital signs and always on standby for emergencies during the procedure.

First of all you will be asked to lie on a table of fluoroscopy machine and multiple monitors will be attached on your body then the doctor will give mild sedation medications so that you can be relaxed during the procedure.

The doctor will insert a needle through the blood vessels in the groin or your wrist to pave the way for the entry of a special and small catheter into the blood vessels. Before the procedure carried out, disinfection and antisepsis in the region, including shaving the hair and skin will be done and also it may be given local anesthesia.

Furthermore, the doctor will push the catheter into the blood vessel to reach the area / target organ. Contrast dye will be inserted through the catheter which may be followed by a sense of warmth during injection (it is normal), while the fluoroscopy x-ray images will be taken to show the flow of the contrast agent and blood flow in the area being examined . Obstructed flow will be seen and indicates the location of the blockage and then the doctor will inject thrombolytic substance to destroy the blockage which is usually a blood clot. In the brain spa procedures, normal saline solution with or without a thrombolytic agent can be injected into the areas that may seem to have poor blood flow so that blood flow can be improved.


Usually you have to rest in bed and doctor will supervise possibility complications. You may receive enough fluids , antibiotics , or pain relievers .
If you feel the following complaint, then you should immediately report to the doctor :

  • Pain in the arms or legs that persist or get worse
  • Fever
  • Shortness of breath
  • Arm or leg changed color to blue, swollen, or felt cold
  • Problems with the insertion site which could be bleeding, swelling, or numbness.
  • Lingering light headedness, nausea, or fainting-like sensation

If your vital signs are good, without any such complaints above, then you are allowed to go home. The doctor will give you instructions and medication for you at home. You are not allowed to lift anything heavy for the first few days. You are also expected to drink enough water so that it can drain contrast agent that enters your body out through the urinary system. You can take a shower after the first 24 hours, but have not been allowed to bathe for the first few days.


Complications may occur after thrombolytic therapy, therefore it needs supervision after the procedure. However, the doctors are already trained to deal with possible complications, such as:

  • Bleeding at the insertion site or any other place
  • Shock or drop of blood pressure
  • Allergic reaction to contrast dye or thrombolytic agents

Bleeding in the brain that lead to a stroke may occur but rarely, it may occur in less than 1 out of 100 patients.
Thrombolytic therapy is not always successful. There is still a possibility that this procedure is unable to destroy the blockages, especially in the blockage that has been long established. In a different incident there were about 12 of the 100 patients who experienced a relapse / form new blockages especially when the underlying factors causing blockage formation in first place has not been recognized or treated properly.