Coronary Angiography

General Description

Coronary angiography, also known as coronary arteriography, is a diagnostic imaging procedure that utilizes X-rays to examine the coronary arteries, which are located in the heart and responsible for supplying blood to the heart chambers.

To visualize the arteries and blood flow, a contrast agent (an iodine-based compound) must be introduced into the arteries, as these are not visible in a conventional X-ray image due to having the same density as the surrounding soft tissues. In a catheter-based coronary angiography, one or more catheters (very thin, flexible tubes) are inserted into the arteries, through which the contrast agent is injected. This procedure is often performed simultaneously with cardiac catheterization (an examination of the left heart chambers). Additionally, coronary angiography allows for the treatment of certain vascular conditions by incorporating specialized instruments through the catheter.

When Is It Indicated?

Coronary angiography helps identify obstructions or blockages in the coronary arteries caused by plaque buildup (atherosclerosis), blood clots, or spasms (muscle contractions of the arterial wall).

This type of coronary arteriography is typically requested if the patient:

• Suffers from angina (chest pain due to reduced blood flow to the heart).
• Experiences unexplained chest pain.
• Has heart failure.
• Has had abnormal results in non-invasive tests, such as an echocardiogram or a stress test.
• Has suffered a heart attack.
• Is scheduled for heart surgery.

Additionally, coronary catheterization is the standard method used to treat arterial narrowing through coronary angioplasty (the placement of a stent to keep the artery open).

How Is It Performed?

In catheter-based coronary angiography, a small incision is made in the groin, neck, or arm to insert the catheter into the corresponding artery. The catheter is then guided toward the heart using X-ray imaging as a guide. Once the catheter reaches the beginning of the coronary arteries at the branching point of the aorta, the contrast agent is injected to visualize the arterial contours and blood flow, allowing the necessary images (known as a coronary angiogram) to be captured. The procedure is recorded on video for later analysis.

There is also a non-invasive form of coronary angiography called computed tomography coronary angiography, in which no catheters are used. Instead, the contrast agent is administered intravenously. However, this is strictly a diagnostic coronary angiography and does not allow for simultaneous treatment procedures.

Risks

During a coronary angiography, there may be an increase in heart rate and a drop in blood pressure, though these are mild conditions that typically resolve immediately. Nausea or vomiting may also occur.

More severe complications, which are rare, include allergic reactions to the contrast agent, kidney damage caused by the contrast, arterial injuries from the catheter, bleeding at the catheter insertion site, infection at the puncture site, blood clot formation, cardiac arrest, or strokeStrokeStroke .

Additionally, exposure to radiation from X-rays increases the long-term risk of developing cancer. However, unless there is prolonged or repeated exposure, this risk is generally considered minimal.

What to Expect from a Coronary Angiography

Before the procedure begins, the patient must remove clothing and metal objects (as metal interferes with X-ray imaging) and wear the medical gown provided by the facility. Once on the examination table, straps are used to keep the patient still, and electrode patches are placed to monitor blood pressure and heart rate throughout the procedure. Additionally, a sedative is administered to help the patient remain calm and relaxed.

The specialist sterilizes and shaves the area where the catheter will be inserted and applies a local anesthetic (in some cases, general anesthesia may be required). After making the incision, the catheter is inserted. The patient will not feel the catheter moving through the arteries. When the contrast agent is injected, it is common to experience a sensation of warmth for a few seconds as the liquid spreads.

A diagnostic angiography typically lasts between 30 and 60 minutes. If angioplasty is also performed, the procedure may take longer. Once the study is complete, the catheter is removed, and pressure is applied to the incision site for a few minutes to prevent bleeding. The patient is then transferred to a recovery room. If the catheterization was performed through the groin, the patient must remain at rest and keep the leg immobile for a few hours (or even stay overnight at the medical facility) to allow the incision to heal properly without bleeding. It is also recommended to drink plenty of fluids to help flush out the contrast agent and avoid physical exertion for the following days.

Specialties That Request Coronary Angiography

Coronary angiography is requested in cardiology and vascular surgery consultations.