Coronary angiography
Coronary angiography is a diagnostic procedure that takes x-ray images (angiograms) of the coronary arteries. A catheter is used in order to inject a contrast medium into the coronary arteries, making them visible. The images obtained in this manner are then stored in a digital format.
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What is coronary angiography?
Coronary angiography - the visualization of the coronary arteries - plays a crucial role in a range of invasive diagnostic procedures that are also known as left heart catheterization.
Coronary angiography is a diagnostic procedure that takes x-ray images (angiograms) of the coronary arteries. A catheter is used in order to inject a contrast medium into the coronary arteries, making them visible. The images obtained in this manner are then stored in a digital format.
What is ventriculography?
Ventriculography (the use of contrast media to visualize the left ventricle during systole and diastole) is a semiquantitative technique that can be used to:
- Investigate regional/global disturbances in wall motion
- Determine the heart's ejection fraction (heart function)
- Measure cardiac output
- Visualize and assess aortic valve and/or mitral valve regurgitation
- Diagnose and visualize ventricular septal defect
- Measure wall thickness
- Visualize tumors of the left ventricle
What happens during coronary angiography?
Once a local anesthetic has been applied, a thin needle is used to create an entry site. A fine wire is then advanced through this entry site and into the artery, where it is used to introduce a sheath that allows long catheters to be advanced through the aorta and towards the heart. The coronary arteries arise from the aorta at a point above the aortic valve. The left coronary artery then divides into two main branches: the left anterior descending artery - or ramus interventricularis anterior (RIVA) - and the left circumflex artery - ramus circumflexis (RCX). The right coronary artery (RCA) supplies the posterior wall of the heart and originates in a separate section of the aorta. Once a contrast medium has been administered, the coronary arteries can be visualized using modern x-ray imaging technology.
In our cardiac catheterization laboratory, 80% of coronary angiograms are performed via an artery in the lower right arm (radial access), with only 20% of angiograms involving a femoral access site in the groin.
In addition to being associated with a much lower risk of bleeding, a radial access site in the lower arm has a further advantage in that after the procedure, the patient does not need to remain in bed for a long time, with a pressure bandage being applied to the area around the entry site.
How did coronary angiography develop?
Modern cardiology has seen enormous technological advances over the past few years, so much so that many of the more complicated procedures involving the coronary arteries can now be performed via access sites in the lower arm (radial access). Femoral access sites in the groin are now required less and less frequently.
The first-ever cardiac catheterization was performed in 1929, Werner Forßmann successfully inserted a thin catheter into one of the veins in his arm, advanced it into the right atrium, and recorded the event on an x-ray image. In 1939, the physicians Cournand and Richards began to perform cardiac catheterization in patients. All three were awarded the Nobel Prize in 1956.
What is coronary angiography used for?
Coronary angiography as part of cardiac catheterization of the left side of the heart is used for the visualization/assessment of the coronary arteries and/or bypass grafts following bypass graft surgery.
This procedure allows for the assessment of coronary artery occlusions and stenoses, and is an indispensable part of the decision-making process prior to possible angioplasty to widen or re-open the coronary arteries.
In spite of the considerable progress that has been made in relation to imaging technologies such as computed tomography, MRI and echocardiography, coronary angiography remains the single most important standard treatment method used in the assessment of the coronary arteries.
When is coronary angiography indicated?
- Acute myocardial infarction (with/without ST segment elevation)
- Stable/unstable angina pectoris
- Suspected coronary heart disease
- Suspected disruption in the normal flow of blood through the coronary arteries, with clinically relevant findings in early diagnostic testing (exercise ECG using stationary bike/treadmill, stress echocardiography or even at rest, cardiac MRI, cardiac CT, myocardial scintigraphy)
- In some cases, as part of check-ups/monitoring following interventions in high-risk patients, particularly if in relation to disease involving the main stem
- Patients with ventricular arrhythmias/who survived sudden cardiac arrest
- Following successful resuscitation
- Heart failure of unknown origin
- As part of diagnostic procedures prior to surgery/intervention in patients with congenital or acquired heart defects
What is the risk of complications during coronary angiography?
When used for diagnostic purposes, the rate of clinically relevant complications associated with cardiac catheterization is less than 1%.