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.
ECG is a simple inexpensive test to asses heart function. ECG is the short form for electrocardiogram or electrocardiography.
ECG equips the doctor with basic heart information such as
An ECG is a simple yet powerful tool to assess the heart function. But at the same time a normal ECG does not rule out a heart attack or other diseases if the disease is quite early stage. If the disease is advanced the ECG remains a quite predictable and powerful tool. So, if the person had a heart attack, we do not entirely rely upon ECG but we additionally incorporate the value of high sensitive troponin to make a confirmed diagnosis of heart attack.
Information obtained from ECG is utilized while interpreting advanced tests such as echocardiography (echo), coronary angiography, cardiac MRI, PET CT scan etc.
ECG is a powerful tool in advanced disease but in the early disease too it could be used as an adjunct to other tests.
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.
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