Coronary angiography: duration, stent, risks, when to do it?

Coronary angiography is a painless examination that allows you to visualize the arteries of the heart. Stent placement may be necessary depending on the results. Principle, duration, anesthesia, rest after…

Coronary angiography is an examination that allows the cardiologist to see the coronary arteries when he suspects coronary artery disease, such as a narrowing of the arteries of the heart for example. This is a invasive examination since it is necessary to puncture thefemoral artery or radial to allow the introduction of a catheter (flexible tube) into the arteries.

In what cases should it be practiced?

How is the exam going ?

What are the risks or adverse effects?

What is the definition of a coronary angiography?

There coronary angiography East an examination to visualize the arteries of the heart (coronary arteries). This is an imaging test using X-ray radiography technique and injection of an iodinated contrast product. “It's a invasive examination, immediately warns the cardiologist. It requires the puncture of an artery (most often the radial artery at the wrist, more rarely the femoral artery at the level of the groin fold) and the circulation of probes to the cardiac arteries.”

What are the indications for a coronary angiography?

Coronary angiography allows precisely visualize the anatomy of the three coronary arteries supplying the heart, and to highlight possible narrowings (stenoses) or occlusions of the arteries by atheroma and/or blood clots and assess their severity.

► First intention: Coronary angiography is the examination carried out during myocardial infarction, in order to identify the artery responsible for the “heart attack”.

► As a second intention: in case angina pectoris (angina) after performing a stress test, stress echocardiography or myocardial scintigraphy.

► Systematically: before cardiac surgery operations (heart valve operation in particular) in order to possibly treat diseased arteries during the same operating procedure.

► “Other indications may be given by the cardiologist, depending on the particular case of each patient“

How is a coronary angiography performed?

The exam takes place in a specially equipped x-ray room. Due to the introduction into the body of material, the procedure is carried out in sterile conditions, like in the operating room. The interventional cardiologist is dressed like a surgeon: sterile coat and gloves, mask and cap. A systematic preliminary questioning will have made it possible to detect possible (but rare) contraindications such as an allergy to the contrast product (iodine). 

► The patient, after having had a local anesthesia, is lying down, with an empty stomach (no drink or food 4 hours before), on an examination table, and a camera rotates around it to acquire images of the coronary arteries from many angles. 

► The interventional cardiologist will prick (puncture) the chosen artery as an approach (radial or femoral) and place a catheter which will allow very thin hollow probes to pass through. The probes are pushed through the circulation to the origin of the heart arteries. Once properly positioned, they allow injection of iodized contrast agent, opaque to X-rays, which makes it possible to visualize all of the coronary arteries via the camera. “The exam is painless. The injection of the contrast product may be accompanied by a feeling of heat“, specifies our interlocutor. 

► At the end of the exam, the probes and catheter are removed and the radial artery (or femoral) is manually compressed to avoid bleeding; then a pressure dressing is put in place and the patient can return to their room.

How long does a coronary angiography take?

A simple coronary angiography generally lasts between 20 and 30 minutes.

Should a stent be placed after coronary angiography?

The results can be divided into two scenarios.

► In the first case, there is no anomaly ; there is therefore no need to offer specific treatment.

► In the second case, lesions are highlighted. Depending on the characteristics of the coronary artery disease, revascularization can be done in two ways:

• Dilation of the diseased artery(s) (angioplasty) and stenting, carried out by the interventional cardiologist,
• Coronary artery bypass grafting performed by the surgeon

Revascularization is not mandatory and certain shrinkages do not justify stent placement or surgery. In all cases (angioplasty, surgery or neither), drug treatment is systematically prescribed to combat coronary artery disease. The choice of treatment depends on different factors and a discussion between the patient, the cardiologist and the surgeon (medical-surgical discussion)

Angioplasty (stent): duration, convalescence after placement

Carried out as part of the management of coronary artery disease, angioplasty makes it possible to dilate narrowed or stenotic coronary arteries to maintain their perfusion. It has undergone several technological revolutions over the last 30 years and constitutes an alternative to coronary artery bypass surgery.

What are the risks of a coronary angiography? Risk of death?

“There is no particular fatigue expected after a coronary angiography, but the illness which motivated the examination can lead to fatigue (particularly heart attack).” explains our interlocutor. Some nausea can nevertheless occur following the injection of iodinated contrast material. Like any invasive examination, coronary angiography presents a risk of complications. “The risk of serious complications is very rare.

 The risk of death is estimated to be less than 1 in 1000“.

What type of anesthesia for a coronary angiography?

The examination is done after local anesthesia of the area where the arterial puncture will then be performed. There is no general anesthesia.

How much rest time afterwards?

Resumption of professional activity depends on the context in which the coronary angiography was performed, and the result of the examination. The cardiologist will specify the duration of the possible work stoppage.

What advice after a coronary angiography? Radial coronary angiography allows the patient to get up almost immediately at the end of the examination. That carried out by the femoral route requires lie down for a few hours to avoid a possible hematoma. Most often, the patient can return home the same evening or the day after the exam. In the event of an abnormality at the puncture point (place where the probes were inserted), medical advice is advisable.