Coronary Angiography
Overview
Coronary arteries are blood vessels that carry oxygen and nutrients to the heart tissue.
Angiography is a medical term that means the visualization of blood vessels.
Therefore, coronary angiography is an imaging study aimed to image coronary arteries.
Since coronary arteries are the vessels that feed the heart, narrowing and occlusions cause damage to the heart tissue, resulting in loss of cardiac functions over time.
To view the coronary arteries, a guide wire is first inserted into an artery of your body. Then, a thin tube, called a catheter, is inserted into the artery through the guide wire. The catheter is advanced over the guidewire to the heart. A contrast agent is administered through the lumen of the catheter and images of coronary arteries are obtained by an imaging device and viewed on a monitor, both available in the procedure room.
Cardiac catheterization implies all procedures carried out until the imaging phase. The room where coronary angiography is performed is the cardiac catheterization laboratory.
Nevertheless, since the primary goal is to minimize damage to the patient for all diseases, non-invasive imaging methods that do not require catheter placement are used before a coronary angiography is considered. Non-catheter Coronary Artery Angiography and MRI Angiography are available in order to be used by our Cardiology and Cardiovascular Surgery Clinics, and these imaging modalities do not require preliminary preparation and catheterization.
Besides, the need for coronary angiography should be supported by non-invasive tests that provide important information about functions of the heart, such as ECG and echocardiography.
Angiography in 4 Seconds
What is Coronary Angiography in Four Seconds?
What are indications?Coronary artery disease is the most common cause of death in developed and developing countries, like our country. Unfortunately, almost half of patient dies while they are transferred to the hospital. This fact had motivated doctors to diagnose the condition early in order to reduce deaths.
Until recently, we had some methods to make early diagnosis, such as cardiac stress test, Echocardiography and Heart Scintigraphy. An insidious disease can be diagnosed by 80% with these methods. Diagnostic value of these methods can sometimes be below 50% in some conditions. Conventional coronary angiography is an invasive method that is used for the definitive diagnosis of the disease, but it requires penetration in coronary arteries and poses some risks, albeit low.
Now, thanks to the developing technology, there is a method that can identifiy the patients especially who are in risk group with almost 100% accuracy. It is a tomography-based method that does not require puncture into cardiac vessels. Accuracy is almost 100 percent and it is a very short lasting procedure; on the contrary to conventional angiography, patient should not stay on bed for 6 hours. Since medications are administered into veins, no problem is faced that is related to the vessel, where medication is administered.
It is even more frequently used by cardiologists since more detailed information is provided about the plaque, the mixture of fat and calcium that occludes the coronary arteries and this information is more useful when treatment is planned for the patient.
There are some factors that determine safety of this valuable technique; and patients should be informed about those factors.
The first one is about the technology of the device. Heart is a moving organ and a device that is supposed to examine the coronary arteries measuring approximately 2-3 mm in diameter in this moving organ should process images very fast. Number of slices is the main factor that determine the process rate. While number of slices was 4, 8, 16 and 40 in old fashioned devices – too low to image a moving organ-, 64 slices are used by new generation devices. Therefore, both patients and doctors should know the number of slices and prefer devices with higher number of slices. One another issue is the experience of the doctor or the team of doctor who review the procedure. Patients should prefer more specialized centers that are further focused in the field of cardiology.
This is an easy method for patients and the procedure lasts only for four seconds after radio-opaque substance is intravenously administered and the patient holds breath.
This method is safely used to determine whether there is an insidious coronary artery disease especially in patients with diabetes, hypertension and family history notable for coronary artery disease as well as smokers even if there is no cardiac complaint. However, patients should necessarily be assessed by a cardiologist before this examination is considered. Because not every patient is eligible for this method and some medications should be given and some measures should be taken before the procedure.
Why is this procedure done?
Since coronary arteries are the vessels that feed the heart, narrowing and occlusions cause damage to the heart tissue, resulting in loss of cardiac functions over time. This condition that is manifested by chest pain, shortness of breath (dysepnia) and poor exercise capacity can lead to serious problems, even including death, if it is left untreated.Coronary angiography is performed for imaging coronary arteries in patients with typical findings of a heart disease, such as chest pain (angina), dyspnea, and chest pain spreading to left arm and jaw. It is also a method of identifying congenital heart defects, cardiac valve diseases and other problems in blood vessels and treating them in the same session, if possible.
Risks
Although the possibility of encountering a risk in coronary angiography is very low, there are still some potential risks. In cardiac catheterization laboratory - the room where coronary angiography is performed-, any and all necessary instrument, equipment and other means to manage the possible risks and complications are available.
• Perforation of the artery imaged
• Cardiac rhythm disorders
• Allergic reactions against the contrast agent
• Bleeding in the punctured artery or another artery located on the route of catheterization
• Infection
• Heart attack
Our specialists will employ all practices to minimize the risk of complications and our doctors will preoperatively inform you about risks listed above and all other potential complications and will address all your concerns.
Preparation
Coronary angiography is performed in two ways, planned (elective) or urgent.
For the urgent angiography, after the patient is admitted to the catheterization laboratory, the basic procedures are applied, such as cleaning the catheter puncture site and administering the necessary medications and the local anesthetic.
In planned or elective coronary angiography, an appointment is first scheduled for the coronary angiography.
A cardiologist and/or other healthcare professional will inform you about what you need to do before you visit the catheterization laboratory at the appointment date. The time you will stop eating and drinking will be instructed. Medications you take for diabetes, hypertension and other disorders are reviewed. You are informed about medications that you should take in the day of the procedure. Besides, you should also inform your doctor about all over-the-counter medications, herbal products and vitamin and mineral supplements.
Before the procedure is performed, your health history is reviewed and a comprehensive physical examination is done, in which all your vital signs (pulse, heart rate, breath rate, core temperature, etc.) are evaluated.
Surgery and early postoperative period
After you have been taken to the catheterization laboratory for the procedure, you will be positioned on the procedure table. This table allows various positions during the procedure. In addition, there are mobile imaging devices that can move around the table to capture images.
An IV line is inserted to allow intravenous treatments and administered medications, if necessary. At this stage, a sedative agent is administered to make you fall into a nap.
All your vital signs will be closely monitored using ECG, pulse oxymeter and anesthesia monitor.
Although an artery located in your groin area is more commonly used for coronary angiography, it is possible to use an artery of your arm.
Radial Angiography (angiography with puncture of radial artery)
The radial artery (an artery in wrist) was first punctured for coronary angiography and PTCA (Balloon dilatation) – stent implantation in 1989. This approach was first adopted by a clinic as routine method for coronary angiography and coronary interventions in 1996. Next, other heart clinics around the world started to use this method. At global scale, almost 500 clinics puncture wrist artery (RADIAL Artery) for coronary angiography, balloon dilatation and stent implantation instead of femoral artery.
The main superiority of radial angiography (coronary angiography with the puncture of radial artery) to angiography with the puncture of femoral artery originates from reduced risk and boosted comfort for patients.
While the risks of vascular dilatation at the puncture site, abnormal links between the artery and the vein, inguinal swelling secondary to uncontrolled bleeding, severe pain and other problems that limit mobilization of the patient are high in angiography with the puncture of femoral artery, they are almost zeroed if radial artery is punctured. Moreover, the possible risk is much lower since radial artery is very thin and there is a second artery that lies parallel to it. Even the radial artery that is punctured occludes, the risk of facing a serious problem is low.
Considering comfort of the patient, radial angiography does not require lying completely immobile on the bed and meeting need to urinate and defecate in the bed – obvious problems for almost everyone. In radial angiography, patients walk to and leave the procedure room independently. They need no assistance for going to bathroom and they are not obliged to stay in bad for 6 hours unlike the angiography with the puncture of femoral artery. In radial angiography, patients are observed for 3 to 4 hours, while mobilization is not limited.
Radial angiography is a technique that is ever increasingly preferred worldwide for the past 7-8 years due to above mentioned advantages.
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After the artery that the catheter will be inserted is determined, the local anesthetic is instilled beneath the skin to make sure you do not feel any pain.
Next, a small incision is made over the artery located at the catheter puncture site and the guide wire is inserted into the artery. Then, the catheter is advanced over the guide wire and contrast agent that helps to visualize the vessels is injected. After all cardiac structures and coronary arteries are visualized, if an abnormality is identified, it is treated in the same session, if possible. Possible treatments include embolectomy, stent placement, repair of congenital and acquired structural abnormalities, and a series of other procedures, mostly related to cardiac rhythm disorders.
Next, the catheters are removed and the procedure is terminated by stitching the small incision.
After the angiography, you will be taken to the observation room. Before you are transferred to the patient room, you should be observed here for a while and it should be verified that all your vital signs are stable or within acceptable limits.
Especially if the artery located in your groin is used, bleeding should be carefully monitored and managed after the angiography. For this purpose, it may be necessary to apply compression on the small incision made in the groin.
Discharge after coronary angiography is entirely related to your health status. If there is no any abnormality, you will usually be discharged on the same day. But, if an abnormality has been identified and intervened, your cardiologist will want you to stay in the hospital for one night or longer, if necessary.
After discharge from the hospital, if you experience signs of infection such as pain, redness and swelling at the incision site in the groin, significant swelling or bleeding at the catheter site, and if you experience chest pain or shortness of breath, it is a vital necessity to seek emergency medical treatment immediately.
Results
Coronary angiography images your heart and coronary arteries to explore an abnormality or a problem.If any problem is identified, it is usually managed in the same session, if and whenever possible, and therefore, your complaints, such as chest pain and shortness of breath, will regress.However, there may be a problem that requires a major surgery, and thus, your doctors will have the opportunity to prepare you for the major surgery at elective settings.
