When is this exam indicated?
Coronary angiography is usually recommended in the following cases:
Symptoms of coronary artery disease, i.e. chest pain (angina pectoris), dyspnea on exertion, neck and/or arm pain, in case of a positive functional test (stress test, myocardial scintigraphy, stress echo) or for evidence of atherosclerotic plaques of significant degree on coronary CT. It is also performed urgently for patients with acute myocardial infarction. In case of significant narrowing of the coronary arteries (due to atherosclerotic plaques or thrombi) is detected during coronary imaging, the procedure for recanalization of the coronary arteries (by balloon angioplasty and stent implantation) is performed immediately.
How is it performed?
The access point for coronarography can be located on the radial artery (which today is the most frequently used access) or through the femoral artery in the groin. To create the access point and insert the cardiac catheter into the vascular system, the cardiologist uses a needle-cannula in the desired area. Then, having prepared the access point and the cardiac catheter in the needle-cannula, he activates the X-ray scanning instrument and places it over the patient's chest. Once the cardiac catheter is inserted into the arterial vascular system, the interventional cardiologist conducts it to the coronary arteries under the guidance of the X-ray imaging instrumentation. Generally, the operation of conducting the cardiac catheter to the heart is not painful and does not cause any other particular sensations; once the coronary arteries are reached, the cardiologist uses the catheter to inject a contrast agent that is visible on X-rays and that serves to study the blood flow within the coronary arteries.
There are no absolute contraindications to coronarography, only relative contraindications; the latter, in particular, are:
- Severe untreated hypertension;
- Severe ventricular arrhythmias;
- Severe anemia;
- Severe allergy to the contrast agent;
- Acute renal failure;
- Electrolyte abnormalities and imbalances (e.g., hypokalemia);
- Severe coagulopathies;
- Active gastrointestinal bleeding.