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Coronary angiography is a method for visualizing the vessels that supply blood to the heart. It is performed in a catheterization room. An opaque substance (contrast agent) visible in X-rays is injected into the heart vessels to observe their anatomy.
Why is it performed? (What kind of complaints should a person have for it to be done?)
It is performed when it is suspected that the coronary vessels are insufficient in supplying blood to the heart muscle, and there is evidence of this. It is a unique diagnostic method applied in cases of patients with chest pain during exertion and abnormal results from stress tests, or in cases of prolonged chest pain that has recently increased or started even at rest, and for planning diagnosis and treatment in cases of sudden heart attack.
When is it performed?
Angiography can be performed almost at any time, but for elective angiography, the patient is required to be fasting for 6 hours. In emergencies, it is performed as soon as possible with necessary precautions.
Is it a risky procedure? What are its risks?
Angiography is an invasive procedure. Therefore, it is not completely risk-free. The most serious risks include: death, stroke, and the possibility of having a heart attack during angiography, but these risks are less than 1 in 1000 overall. Other more common risks include:
- Allergy related to the contrast agent used,
- Complications at the site of angiography (hematoma, fistula between artery and vein, aneurysm which is ballooning of the vessel wall).
- Rarely, acute kidney failure related to the contrast agent in some patients.
Is there any harm from the radiation taken during angiography?
During angiography, while the contrast agent passes through the vessel, an X-ray is taken for 2-3 seconds to obtain an average of 6-7 images, and the amount of radiation received is not harmful to health.
What should be considered during the preparation phase before angiography?
There are certain medications that need to be discontinued before angiography. The patient will be informed about this by their doctor. Additionally, in planned cases, a 6-hour fasting period is required. Other than that, no special preparation is necessary unless specified by the patient’s doctor.
From which parts of the body is angiography performed?
It is commonly performed from the femoral artery in the groin area and the radial artery in the wrist. Less frequently, if these two vessels are not suitable, it may be performed from the brachial artery in the inner elbow area.
Is it a painful procedure?
It is performed under local anesthesia. Depending on the individual’s pain threshold, generally, there is not much pain felt beyond the pain of the needle used for local anesthesia.
Is there any harm from the medication used during angiography?
It can rarely cause an allergy. In some high-risk patients (those with known kidney failure or at risk of kidney failure, and some diabetics using certain medications), it can cause kidney failure.
Is it healthier to perform it from the groin or the arm?
It varies depending on the physical characteristics of the person undergoing angiography. If the patient has known blockages in the abdominal and leg vessels, especially in overweight individuals in the groin and abdominal area, performing angiography from the arm is healthier to reduce complications. Additionally, in slender individuals, the wrist artery is thin, so performing angiography from the groin will be easier and healthier for both the patient and the physician.
What are the differences, advantages, and disadvantages between angiography performed from the arm or groin?
Once the coronary vessels are reached, there is no difference in the images and interpretations obtained from angiography performed through either route. Only the radial artery used for angiography from the wrist does not have a vein or nerve nearby. Also, since this artery runs more superficially, it is easier to control bleeding in this vessel after angiography compared to the groin artery. In summary, complications related to the entry site (bleeding, swelling) in angiography performed from the wrist are negligible. However, the wrist artery is thinner than the groin artery and is more prone to spasms during the procedure, which can hinder access to the coronary vessels, especially in slender individuals.
What does the patient feel during angiography? Is it performed under general anesthesia?
It is usually performed under local anesthesia. Besides a slight burning sensation felt when the local anesthetic is injected, no additional pain is felt. There may be a sensation of palpitations due to arrhythmias while the catheter is in the coronary vessels or inside the heart. Rarely, nausea and vomiting may occur due to the contrast agent. Therefore, elective angiographies are requested to be performed after a 6-hour fasting period. The contrast agent injected into the heart cavity for evaluating heart contractions usually causes a temporary (lasting about 20-30 seconds) burning sensation in the chest and face.
What information is obtained from angiography?
In angiography, the coronary vessels are visualized; information is obtained about the size of the vessels, the diameter of the vessels, whether there is any narrowing in the vessels, if narrowed, how much it is narrowed, where the narrowing is located, the length of the narrowing, whether there is calcification in the narrowing, whether there is a clot inside the vessel, and whether the vessel is straight or curved. Coronary angiography is entirely a diagnostic method. Based on the results, treatment (medication, balloon-stent-bypass) is planned.
If there is a closed vessel, is angioplasty performed?
In heart vessel diseases; there are narrowings in the vessels, which also have degrees, or there may be complete blockages. The decision to perform angioplasty, which is the opening of the coronary vessels with a balloon and/or stent, is made based on the location, degree, diameter, and length of the narrowing or blockage. Especially in cases of sudden heart attacks, the blocked vessel can usually be opened with angioplasty after the angiography performed in the first minutes and hours.
How is angioplasty performed?
If the narrowing or blockage detected by angiography is suitable for opening with angioplasty: a guide wire is advanced through the catheter placed at the entrance of the coronary vessel, passing through the narrowing in the vessel. Depending on the characteristics of the vessel structure, the physician may decide to first dilate the narrowing with a balloon and then apply a stent, or to apply a stent directly without any balloon.
What is a stent? What is it used for? What are its features?
When a balloon is applied to the narrowing area in the vessel, the plaque causing the narrowing adheres to the vessel wall, and stents, which can be defined as a steel cage placed inside the vessel wall to prevent this plaque from narrowing the vessel lumen again, are used. Although stent technologies are rapidly changing today, stents can roughly be divided into two categories: drug-eluting stents (drug-coated stents) and non-drug-eluting stents (normal stents). The most significant disadvantage of normal stents is that the stent placed may need to be intervened again within 6 to 8 months due to re-narrowing. The risk is lower with drug-eluting stents (less than 10%). However, this does not mean that using drug-eluting stents is more appropriate for every patient. The choice between normal stents and drug-eluting stents is made by the physician based on the patient’s characteristics (presence of diabetes, previous stent placement with re-narrowing, etc.) and the characteristics of the vessel where the stent will be placed (is the vessel diameter small, is the length of the narrowing excessive, etc.).
How long should one rest after angiography (in the hospital and at home)?
After angiography performed from the groin artery, the patient needs to rest lying down for 4-6 hours for bleeding control. After this, if there is no problem in the groin area under the physician’s supervision, the patient can mobilize and will be discharged after 1-2 hours of observation in the hospital. In angiography performed from the wrist, the patient can mobilize immediately after the procedure. Again, after 1-2 hours of observation, they can be discharged. At home, unless specified otherwise by the patient’s doctor, the person can return to their normal life the next day.
What should the person pay attention to after angiography?
After angiography performed from the groin area, it is not recommended to travel long distances or lift heavy objects within 1-2 days. Similarly, after angiography performed from the wrist, heavy lifting is not recommended for a few days.
Will there be pain?
Normally, pain at the entry site is not expected after angiography. However, a slight pain may be felt.
In which situations should the doctor be contacted immediately?
- Bleeding at the site of angiography,
- Swelling,
- Presence of a large bruise or severe pain covering a wide area,
- Symptoms of low blood pressure should prompt a visit to the hospital for evaluation by a physician.
