Coronary angiography is one of the methods we most often use to diagnose coronary artery disease. Yet for many patients, it is a procedure they do not fully understand, and this uncertainty can cause anxiety.
What exactly is angiography? How do we reach the arteries of the heart? Does the procedure involve an intervention on the heart itself? Is it painful? Does it use radiation? And perhaps one of the most important questions: is angiography the same as opening a blocked artery?
Let’s take a closer look at what coronary angiography involves.
What is coronary angiography?
Coronary angiography is an invasive diagnostic procedure that allows us to visualise the coronary arteries supplying the heart.
The heart is a muscle that pumps blood throughout the body. To keep doing this, it needs its own supply of oxygen and nutrients, which it receives through vessels called the coronary arteries.
Over time, atherosclerosis — the build-up of plaque in the arteries — can cause these vessels to narrow or become blocked.
Coronary angiography allows us to see the anatomy of these arteries and assess the location and severity of any narrowing or blockages.
Let’s clear up a common misunderstanding: angiography is not a procedure for opening blocked arteries.
The procedures we use to open narrowed or blocked coronary arteries with balloons and stents are called percutaneous coronary intervention (PCI).
PCI can be performed in the same setting as angiography, using similar catheter techniques. When necessary, it can even be performed immediately after coronary angiography, during the same session.
However, they are not the same procedure. Coronary angiography aims to visualise the arteries, whereas PCI aims to treat narrowing or blockages considered suitable for intervention.
Which narrowings need treatment is a separate topic in its own right. We will discuss this in detail in another video.
How is coronary angiography performed?
Coronary angiography is performed in a specialised setting called a catheterisation laboratory, or cath lab.
To reach the coronary arteries, we generally use an artery at the wrist, or in some cases an artery in the groin.
First, we numb the entry site with a local anaesthetic. We then insert a small introducer sheath into the artery and advance thin, flexible tubes called catheters through it.
These catheters travel through the arteries to the openings of the coronary arteries supplying the heart.
We track the catheters using fluoroscopy, a method that provides real-time X-ray images.
An important detail: during coronary angiography, we do not pierce the heart muscle or open the chest. The catheters travel inside the blood vessels.
How are the coronary arteries visualised?
It is not possible to see the coronary arteries in detail on a standard X-ray image.
We therefore inject a special liquid called contrast medium into the coronary arteries through the catheters.
The contrast medium makes the vessels visible under X-rays.
Fluoroscopy allows us to follow the contrast medium as it moves through the vessels in real time. Images taken from different angles help us assess the course and branches of the coronary arteries and any areas of narrowing.
In essence, coronary angiography involves visualising the heart’s arteries using contrast medium and fluoroscopy.
Does coronary angiography use radiation?
Yes. To visualise the arteries during coronary angiography, we use fluoroscopy, an imaging method based on X-rays. The patient is therefore exposed to a certain amount of ionising radiation during the procedure.
Is this radiation dangerous?
First, it is important to understand that radiation is not completely harmless. Ionising radiation has the potential to slightly increase the long-term risk of cancer. Very high doses can also cause problems such as radiation-related skin injury. However, such serious effects are very rare in routine diagnostic coronary angiography.
There is another point that often catches patients’ attention. During the procedure, you may see doctors and other healthcare professionals wearing lead aprons, thyroid shields and, when needed, additional protective equipment.
Why do we use so much protection?
Because we work in the cath lab almost every day, sometimes being exposed to radiation several times a day. For us, the concern is the cumulative effect of repeated occupational exposure over an entire career.
Most patients do not have this kind of ongoing exposure. Having angiography once or a few times is not the same as working in a cath lab every day for years.
Of course, this does not mean that radiation is completely harmless for patients. Nor is the radiation dose the same in every angiogram. The duration of the procedure, the patient’s body size and the complexity of the procedure can all affect the amount of radiation received.
Our guiding principle is therefore to keep radiation exposure for patients and staff as low as possible while obtaining images of sufficient quality for diagnosis.
In summary, angiography does use radiation, and this carries certain risks. However, when coronary angiography is genuinely necessary, its medical benefits generally far outweigh the potential risks associated with radiation.
What is the difference between wrist and groin access?
We use two main arterial access routes for coronary angiography.
Wrist access (the radial approach): the procedure is performed through the radial artery at the wrist. It is frequently preferred in suitable patients today. One of its important advantages is a lower risk of major bleeding related to the access site.
Groin access (the femoral approach): the procedure is performed through the femoral artery in the groin. Certain anatomical or technical circumstances may make this route preferable.
Both approaches have the same basic aim: to visualise the coronary arteries.
The choice of approach depends on the patient’s vascular anatomy and clinical characteristics.
Is coronary angiography painful?
This is one of the questions our patients ask most often.
Coronary angiography usually does not require general anaesthesia. Patients are generally awake during the procedure and can communicate with us.
There may be a brief stinging sensation when the local anaesthetic is injected at the arterial entry site.
However, the movement of the catheters inside the vessels does not normally cause pain.
If you experience any discomfort during the procedure, it is important to tell the team performing it.
What happens to the heart during angiography?
This question often stems from the idea that the catheters are inserted directly into the heart’s chambers.
In routine coronary angiography, catheters are advanced through the arterial system to the points where the coronary arteries arise from the aorta.
Contrast medium is injected at these openings to visualise the coronary arteries.
There is therefore no need to open the chest or cut the heart muscle during the procedure.
Nevertheless, angiography is an invasive medical procedure and does carry certain risks.
Is coronary angiography risky?
Coronary angiography is generally safe when performed under appropriate conditions. However, it is not entirely risk-free.
Complications such as bleeding, bruising or blood vessel injury can occur at the access site.
Allergic reactions to the contrast medium and a deterioration in kidney function in some patients are also possible.
Serious complications such as heart attack, stroke and death are rare.
The level of risk varies according to the patient’s clinical condition, other medical conditions and the characteristics of the procedure.
For this reason, coronary angiography is performed when considered necessary, after weighing its benefits against its potential risks.
Why is coronary angiography performed?
The main purpose of coronary angiography is to assess the anatomy of the arteries supplying the heart.
It can provide important information in selected patients with suspected or established coronary artery disease.
Angiography may be necessary in patients having a heart attack, in certain high-risk clinical situations, or when other tests suggest severe coronary artery disease.
However, not everyone with chest pain needs an angiogram.
The decision is made by considering the patient’s symptoms, examination findings, electrocardiogram and other test results together.
Frequently asked questions about angiography
Is angiography an operation?
Coronary angiography is an invasive diagnostic procedure performed using catheters. It is not open-heart surgery.
Is the heart stopped during angiography?
No. The heart does not need to be stopped during routine coronary angiography. It continues beating normally.
Is the patient put to sleep during angiography?
Usually not. The procedure is performed under local anaesthesia. Sedative medication may be used when needed.
What substance is used during angiography?
An iodine-containing contrast medium is used to visualise the coronary arteries. It makes the vessels visible on X-ray images.
Are patients exposed to radiation during angiography?
Yes. Coronary angiography uses fluoroscopy, which relies on X-rays to visualise the arteries. The amount of radiation received varies with the patient’s characteristics and the complexity of the procedure. To minimise potential harm, we aim to obtain adequate image quality using the lowest possible dose.
Is angiography only performed through the groin?
No. Coronary angiography can be performed through the wrist or the groin. Wrist access is frequently preferred in suitable patients.
Can angiography detect every heart condition?
No. Coronary angiography is primarily used to assess the anatomy of the coronary arteries. Other tests may be needed to evaluate heart valve disease, rhythm disorders and other structural problems.
Conclusion
Coronary angiography is an important diagnostic method that allows us to visualise the arteries supplying the heart.
The principle behind it is straightforward: thin catheters are advanced through an artery, contrast medium is injected into the coronary arteries, and the vessels are visualised using fluoroscopy.
And to reiterate: angiography is not the same as opening a blocked artery. Procedures to open narrowed or blocked coronary arteries are called percutaneous coronary intervention. We will discuss this in detail in another video.
Accurate information about angiography can help patients understand the procedure and ease unnecessary anxiety.