ANGIOGRAPHY

What is Coronary Angiography?

• The most detailed and accurate way to visualize the coronary arteries is coronary angiography.

• Coronary angiography is not a treatment but a diagnostic method. It is based on visualizing the heart chambers and coronary arteries by injecting contrast dye (a medical dye substance) and recording moving images using X-rays.

• Coronary angiography is performed in laboratories equipped with angiography devices and staffed by trained and experienced doctors and healthcare personnel.

• Coronary angiography is definitely not a surgical operation. The patient does not need to be put to sleep for the procedure; they remain awake and able to talk throughout the process.

• The data obtained from coronary angiography are extremely valuable for guiding treatment and often serve as the main determinant for selecting the treatment strategy. With current technological conditions and accumulated knowledge, the success rate of these procedures exceeds 99%.

• It is one of the most important procedures performed for the diagnosis of heart diseases. By imaging the arteries that supply blood to the organs, angiography provides diagnostic information about vascular diseases or the organs supplied by these vessels. Additionally, depending on the findings, angiography may also be used for therapeutic purposes.

When is Coronary Angiography Performed?

• In the presence of chest pain (angina pectoris) suggestive of coronary artery disease with significant risk factors,

• In patients experiencing a heart attack,

• In patients showing abnormalities during post-heart attack evaluations (exercise test, thallium scintigraphy, CT angiography),

• When chest pain recurs in patients who previously underwent angioplasty, stent placement, or bypass surgery,

• In patients requiring cardiac surgery (such as valve disease) or non-cardiac surgery at an older age,

• In patients with severe, unexplained life-threatening arrhythmias (VT – VF),

• In patients with unexplained heart failure,

• When diagnostic tests suggest vascular disease despite no symptoms being present,

• Depending on the type of heart attack, either immediately or after treatment to assess coronary arteries,

• In diabetic patients where chest pain may not occur, and in elderly patients where symptoms may present as neck, back, abdominal, or even tooth pain instead of chest pain.

In conclusion;

• The decision for coronary angiography is made by your doctor after evaluating your complaints and risk factors.

Why Are Coronary Arteries Important?

• When these arteries become blocked (myocardial infarction or heart attack), the areas of the heart they supply suffer damage and impaired contraction.

• It is extremely important for these arteries to remain open. In the condition called atherosclerosis (coronary artery disease), plaques form in the arteries, leading to narrowing or blockage over time, disrupting the blood supply to the heart muscle, and causing serious complications.

How is Coronary Angiography Performed?

• Patients must fast for about 4 hours before coronary angiography (medications can be taken with a small amount of water). A mild sedative may be administered if necessary.

• To access the coronary arteries, the radial artery in the wrist is most commonly used today, or the femoral artery in the groin as was commonly used before. The site is numbed with a fine needle and a plastic sheath is placed in the artery, which will be removed after the procedure. Patients may feel slight discomfort during this part.

• This is the only discomfort the patient experiences. Afterward, the patient feels nothing. A thin hollow tube called a catheter is guided through the sheath into the coronary arteries, and contrast dye is injected to make the arteries visible under X-ray imaging. Images are taken from different angles. The procedure lasts about 20–30 minutes.

• Once completed, the sheath is removed and pressure is applied to the site for 10 minutes to stop bleeding. Afterward, the site is bandaged. For wrist angiography, patients can walk around after routine checks. For groin angiography, a weight (sandbag) is placed on the site and patients must lie down for about 6 hours.

• After the procedure, the cardiologist informs the patient about the results and treatment options, and provides an angiography report. Depending on the doctor’s evaluation, the patient can usually go home the same day or the following day.

• Patients are advised not to strain the procedure site for 24 hours after leaving the hospital.

• After 24 hours, the bandage can be removed, and showering is allowed. Bruising may occur due to blood leakage under the skin but this is not serious. Bruises usually resolve within a few weeks. However, if there is bleeding, severe pain, or sudden swelling at the site, immediate medical attention is required.

How Are Angiography Results Evaluated?

• The recordings obtained during the procedure are evaluated by a cardiologist, who determines the appropriate treatment plan.

• Most patients with diagnosed conditions require medication and/or interventional treatment (such as balloon angioplasty or stent placement).

• Surgical treatment is still important; however, advances in interventional cardiology have significantly reduced its frequency over the years.