Coronary angiography is a procedure that uses X-rays to visualize and inspect arteries. It shows if there are any blocked arteries and how well your heart muscle is working.
During this procedure, a catheter is inserted into an artery in your arm or groin and advanced into one of your coronary arteries. Thereafter, contrast dye is injected into the coronary artery to make it visible on X-ray images.
The procedure can help identify blockages in the heart’s blood vessels and guide treatment decisions for patients at risk of developing heart disease or having a heart attack due to narrowed or blocked blood vessels that supply oxygenated blood to various organs.
Coronary angiography is typically performed if you have chest pain or other symptoms that suggest the presence of heart disease. If you have had a heart attack or have been diagnosed with coronary artery disease. It can be used in conjunction with an exercise stress test.
If you’re scheduled for coronary angiography, here’s what you can expect:
Coronary angiography is performed in a cath lab (catheterization laboratory). The cath lab is a room with special equipment for performing coronary angiography and other procedures that entail inserting a long, thin tube (called a catheter) into the blood vessels of your heart.
Advancements in medical science have made coronary angiography more accessible to patients. The procedure has become simple and the risk has reduced significantly. Also, unhealthy diets and lifestyle choices put more people at risk of developing cardiac ailments. That’s why coronary angiography is commonly performed now-a-days.
In expert hands coronary angiography is a near-zero risk procedure. The risk of complications can be broadly categorized into:
Less severe complications
The chance for developing a serious complication during coronary angiogram is 1 in 1000. People with serious underlying heart problems are most at risk. Discuss with your cardiologist about the risks before the procedure.
Coronary angiography is used to diagnose and treat heart diseases, before cardiac surgery, angioplasty-stent procedures as well as other conditions such as aneurysms in blood vessels. It helps doctors identify underlying causes of heart failure and determine the proper course of treatment.
Dr. C Raghu is a renowned cardiologist with decades of experience in interventional cardiology. He is one of the pioneers of trans-radial procedures in India. Consult him if someone is in need for coronary angiogram.
Coronary angiography is a common diagnostic test used by doctors to identify conditions, such as coronary artery disease and aneurysms. In our previous blog, we discussed how the procedure is carried out and when it’s used. Click here to check it out.
Angiography is a minimally invasive procedure, which makes it extremely safe. However, it can involve a few minor side effects. The benefits outweigh the risks for most patients. However, in some cases, coronary angiography can result in serious complications.
In this article, we’ll delve deeper into the risks and side effects associated with coronary angiography.
If you’re planning to visit the doctor for an angiography, you can expect one or more of the following side effects:
All these symptoms are localized to the area where the cut was made for inserting the catheter. Most patients experience a gradual improvement in these side effects without medical intervention. You can take painkillers to relieve discomfort after the procedure.
If you’re lucky, you’ll come out of coronary angiography with minor bruising and swelling. However, some patients develop the following complications:
In both cases, proper use of medications can help control the side effects. For instance, antibiotics can be used in the case of an infection. Similarly, your doctor might prescribe antihistamines if you experience an allergic reaction.
It’s worth mentioning that coronary angiography comes with a few potential serious complications. These include:
The good news is that these complications are extremely rare (affecting less than one in every 1000 patients). Also, kidney damage due to angiography is usually temporary. Moreover, internal bleeding can be contained with the help of catheter based approaches.
Complications from coronary angiography are rare. Nevertheless, it’s a good idea to consult your doctor if you notice anything unusual after the procedure. For instance, if the leg or arm where the cut was made looks pale or feels numb, it’s a cause for concern. Similarly, if you notice bleeding, redness, or a firm lump near the cut, it could indicate a potential infection. It’s always a good idea to watch out for these signs and consult your doctor for timely treatment.
Coronary angiography is a safe and minimally invasive procedure. It can cause minor side effects, such as pain and swelling. However, in extreme cases, it can also lead to a heart attack or kidney damage. It’s crucial to talk to your doctor about the potential risks before going in for the procedure.
Dr. C Raghu has more than two decades of experience in treating patients with different heart conditions. If you have queries or concerns about coronary angiography, feel free to reach out to Dr. Raghu today.
Coronary arteries are the vessels which supply blood (oxygen and nutrients) to the heart; this supply may be disrupted due to buildup of cholesterol and fatty deposits, called plaques, on the inner walls of the arteries (atherosclerosis) causing narrowing of the vessel lumen.
Coronary lesions branch out as they progress to supply various cardiac structures. A bifurcation lesion is a stenosis or abnormal narrowing of greater than 50% that occurs in a coronary artery at the origin of the side branch or adjacent to the origin of the side branch. Branching points a.k.a bifurcation points in the coronary arteries are prone to develop atherosclerosis as the shear stress is higher at the branch points.
The figure shows how a bifurcation stenosis appears schematically as well as on angiography.
A vast majority of coronary arteries obstructions happen at the branching point. About 15-20% of patients of referrals for bypass surgery are because of the presence of coronary narrowing at bifurcation location. They are considered a tough lesion to treat by angioplasty and stent.
Bifurcation lesions are identified on coronary angiography. Only lesions affecting side branch blood vessels more than 2.25 mm is considered important and called bifurcation lesions. The main vessel that gives branches is called main vessel and the branches that originate from it are called side branches. The point at the division of the main vessel and side branch is called a bifurcation point.
Bifurcation lesions can involve the coronary artery either before or after the bifurcation point. In addition, side branches could be either diseased or free from disease. Based on the location and severity of the cholesterol plaque at the bifurcation point, sub types of bifurcation lesions have been identified.
The challenge of performing angioplasty and stent for a bifurcation stenosis lies in the ability to preserve the main vessel and the side branch. Stents being metallic tubes risk occluding the side branch when placed across the side branch. This apprehension of losing the side branch, is one of the primary reasons for patients to be sent for bypass surgery instead of angioplasty and stent.
Angioplasty and stent can be eminently performed for a bifurcation stenosis. Over the last 2 decades numerous techniques in stent implantation have been developed to treat the bifurcation lesions. Some of these techniques include:
Advent of these techniques enabled experienced operators to perform angioplasty and stent successfully with chances of repeat narrowing seen in 3-6% patients at the site of stenting. Risk of losing a side branch after stenting is reduced to 1% once the new techniques are employed.
Dr. C Raghu is an expert in bifurcation lesion angioplasty and the center where he has been trained, ICPS Paris France is considered the “Mecca” for bifurcation lesion angioplasty techniques development.
Bifurcation lesion angioplasty, involves utilization of novel stent techniques mentioned above. In addition, angioplasty operator experience is a major factor in determining outcomes. Choosing the “right” stent that allows side branch access, use of specialized technologies such as fractional flow reserve (FFR), expertise in deploying 2 stents especially the process of “stent crush” and the handling of two balloons through a single catheter – kissing balloon are key points for the best results in a stent procedure.
Contemporary bifurcation angioplasty using Intravascular imaging employing contemporary stenting techniques in the hands of expert bifurcation angioplasty operators carries a 99% success rate with a chance of losing side branch in 1% and repeat narrowing at the end of 9 months being 3-6%. These results are comparable and if not superior to bypass surgery as angioplasty entails a short hospital stay and fast recovery.
Coronary arteries are the blood vessels that delivers oxygenated blood to the heart muscle. But, sometimes these blood vessels may get narrowed or blocked due to accumulation of cholesterol plaque. To open the blockage and restore the function of arteries, coronary angioplasty is performed.
A coronary angioplasty involves the temporary insertion of a tiny balloon inside the artery to open the blockage. It is usually combined with the placement of a stent (a metal mesh tube) to widen the artery and prevent the further chance of narrowing.
Coronary angioplasty is done to treat narrowing or blockage of the heart’s blood vessels:
Usually, it is a safe procedure, but like all other procedures, it also carries certain risks like:
|Common Issues/Risks after angiography|
|Bruising||Common to have bruise at groin or arm Lasts for few weeks Not to be worried about|
|Allergic reactions||Usually related to contrast medicine used History of previous allergy – higher risk Present as rash and headache|
|Bleeding at the site of entry (Hematoma)||Usually subsides in a few days But in case swelling is increasing and painful contact your physician immediately|
|Serious complications after coronary angiography||Less than 1 in 1000 chance People with severe heart disease are at high risk Discuss with Cardiologist before procedure|
|Heart attack||A serious medical emergency where the heart’s blood supply is suddenly blocked|
|Stroke||A serious medical condition that occurs when the blood supply to the brain is interrupted|
|Loss of blood supply to limb||Damage to the artery in the arm or groin in which the catheter was inserted, with the blood supply to the limb possibly being affected|
|Kidney injury||Damage to the kidneys caused by the contrast dye|
|Radiation injury||Tissue damage caused by X-ray radiation if the procedure is prolonged|
A physical examination and blood test are done to evaluate the overall health condition. The person needs to follow instructions provided before undergoing the procedure:
1. Inform the doctor about:
Tell the doctor if you are using blood thinners or any anti-diabetic medicines. The doctor will either advise you to stop or change the dose of the medication.
3. Food and fluid restrictions:
In most of the cases, you will be discharged on the same day of the hospital, so ask someone to accompany you to the hospital.
Coronary artery disease (CAD) is the most common type of heart disease, in which the coronary arteries ( blood vessels that supplies oxygen and nutrients to the heart muscle) become rigid and narrowed due to buildup of plaque (deposition of cholesterol) in the inner walls of the heart. This restricts the flow of oxygen rich blood to the heart muscle, which may result in angina (chest pain) and shortness of breath. If the plaque ruptures or due to a complete blockage in the artery, it may result in heart attack or sudden cardiac death.
Build of cholesterol plaques within the blood vessels is termed atherosclerosis.
The plaque makes the inner walls of the artery sticky, so that the inflammatory cells, lipoproteins, and calcium travelling through the blood stream and adhere to the plaque. The plaque gradually enlarges, narrowing the blood vessel lumen, restricting blood flow to the heart muscle and thus reducing the supply of oxygen and nutrients to the heart.
If left untreated, CAD can lead to life threatening complications such as:
The diagnostic work up includes a physical examination, in addition to medical history, family history, risk factors and any signs and symptoms of CAD. Further diagnostic tests may be recommended:
The doctor may prescribe medications, which help in reducing symptoms and severity of disease such as:
To maintain healthy arteries and to prevent coronary artery disease, some measures need to be taken such as lifestyle modifications which includes avoiding smoking and alcohol use, exercising regularly to maintain healthy weight, controlling sugar and cholesterol levels in blood and also eating a healthy diet.
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