Coronary angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the arteries in your heart.
An angiogram is an X-ray image of blood vessels after they are filled with a contrast material. An angiogram of the heart, a coronary angiogram, is the “gold standard” for the evaluation of coronary artery disease (CAD). A coronary angiogram can be used to identify the exact location and severity of CAD.
An interventional radiologist performs this X-ray procedure, which is also called an angiogram. During the angiogram, the doctor inserts a thin tube (catheter) into the artery through a small nick in the skin about the size of the tip of a pencil. A substance called a contrast agent (X-ray dye) is injected to make the blood vessels visible on the X-ray.
One of the most common reasons for angiograms is to see if there is a blockage or narrowing in a blood vessel that may interfere with the normal flow of blood through the body. In many cases, the interventional radiologist can treat a blocked blood vessel without surgery at the same time the angiogram is performed. Interventional radiologists treat blockages with techniques called angioplasty and thrombolysis.
How the Test is Performed
Coronary angiography is often done along with cardiac catheterization.
Before the test starts, you will be given a mild sedative to help you relax.
An area of your body (the arm or groin) is cleaned and numbed with a local numbing medicine (anesthetic). The cardiologist passes a thin hollow tube, called a catheter, through an artery and carefully moves it up into the heart. X-ray images help the doctor position the catheter.
Once the catheter is in place, dye (contrast material) is injected into the catheter. X-ray images are taken to see how the dye moves through the artery. The dye helps highlight any blockages in blood flow.
The procedure may last 30 to 60 minutes.
Coronary angiography is performed with the use of local anesthesia and intravenous sedation, and is generally not significantly uncomfortable.
- In performing a coronary angiogram, a doctor inserts a small catheter (a thin hollow tube with a diameter of 2-3 mm) through the skin into an artery in either the groin or the arm.
- Guided with the assistance of a fluoroscope (a special x-ray viewing instrument), the catheter is then advanced to the opening of thecoronary arteries (the blood vessels supplying blood to the heart).
- Next, a small amount of radiographic contrast (a solution containing iodine, which is easily visualized with X-ray images) is injected into each coronary artery. The images that are produced are called the angiogram.
- The procedure takes approximately 20-30 minutes.
- After the procedure, the catheter is removed and the artery in the leg or arm is either sutured, “sealed,” or treated with manual compression to prevent bleeding.
- Often, if an angioplasty orstent is indicated, it will be performed as part of the same procedure.
How the Test will Feel
In most cases, you will be awake during the test. You may feel some pressure at the site where the catheter is placed.
You may feel a flushing or warm sensation after the dye is injected.
After the test, the catheter is removed. You might feel a firm pressure being applied at the insertion site to prevent bleeding. If the catheter is placed in your groin, you will be asked to lie flat on your back for a few hours to several hours after the test to avoid bleeding. This may cause some mild back discomfort.
Why the Test is Performed
Coronary angiography may be done if you have:
- Angina for the first time
- Angina that is becoming worse, not going away, occurring more often, or happening at rest (called unstable angina)
- Aortic stenosis
- Atypical chest pain, when other tests are normal
- Had an abnormal heart stress test
- To have surgery on your heart and you are at high risk for coronary artery disease
- Heart failure
- Recent heart attack
There is a normal supply of blood to the heart and no blockages.
What Abnormal Results Mean
An abnormal result may mean you have a blocked artery. The test can show how many coronary arteries are blocked, where they are blocked, and the severity of the blockages.
Cardiac catheterization carries a slightly increased risk when compared with other heart tests. However, the test is very safe when performed by an experienced team.
Generally the risk of serious complications ranges from 1 in 1,000 to 1 in 500. Risks of the procedure include the following:
- Cardiac tamponade
- Irregular heartbeats
- Injury to a heart artery
- Low blood pressure
- Allergic reaction to contrast dye
- Heart attack
Considerations associated with any type of catheterization include the following:
- In general, there is a risk of bleeding, infection, and pain at the IV site.
- There is always a very small risk that the soft plastic catheters could damage the blood vessels.
- Blood clots could form on the catheters and later block blood vessels elsewhere in the body.
- The contrast dye could damage the kidneys (particularly in patients with diabetes).
If a blockage is found, your health care provider may perform a percutaneous coronary intervention (PCI) to open the blockage. This can be done during the same procedure, but may be delayed for various reasons.
Cardiac angiography; Angiography – heart; Angiogram – coronary
ADDITIONAL REASONS FOR PERFORMING ANGIOGRAPHY OR ANGIOGRAM
- aneurysms — an area of a blood vessel that bulges or balloons out
- cerebral vascular disease, such as stroke or bleeding in the brain
- blood vessel malformations