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Coronary Angiography

What is Coronary Artery Disease?

Coronary Artery Disease (CAD) is the disease that occurs due to the narrowing or occlusion of the arteries that feed the heart muscle and called the coronary arteries, and the partial or complete cessation of blood flow. Various tests such as ECG, blood tests, exercise test, echocardiography, nuclear cardiological examinations, magnetic resonance, and multislice tomography are used in the diagnosis of coronary artery disease. Coronary angiography is the diagnostic tool that best shows the structure of the coronary vessels. After the coronary angiography procedure, drug treatment can be decided without any procedure. Balloon angioplasty and/or a stent (steel cage) can be applied to open the appropriate stenosis or obstruction, or coronary bypass surgery can be recommended.

What is coronary angiography?

Coronary angiography is an imaging method used to view the coronary arteries that feed the heart and to detect whether there is narrowing in these vessels.

Angiography is an imaging method used to view the vessels in the body by means of X-rays. With this method, stenosis, occlusion, enlargement and other problems of arteries (arteries) and veins (veins) are displayed.

There is a separate technique for imaging the veins of each vascular region (heart, lung, brain, neck veins, arm and leg veins, veins of internal organs). The imaging of the coronary arteries that feed the heart is also called coronary angiography.

In which situations is coronary angiography performed?

To diagnose coronary artery disease such as angina (chest pain) by illuminating the symptoms
Chest, jaw, neck, shoulder and arm pain that cannot be explained in other ways
New onset or increasing chest pain
To explain abnormal stress test results
To find out where the blockage is after a heart attack
To determine where the coronary artery stenosis is in chest pain due to coronary artery disease.
For procedural planning before interventions such as coronary stent and bypass surgery
To confirm the diagnosis of coronary artery disease
To determine if coronary arteries and heart have been damaged after chest trauma
For preparation for surgery in valve diseases
For diagnosis and preparation for surgery in congenital heart diseases

How is coronary angiography performed?

Before coronary angiography, the patient is usually asked to fast for 8 hours and to shave the pubic hair if it is to be entered through the groin.
For coronary angiography, a thin plastic tube called a catheter, which is inserted into the artery from the patient’s wrist or groin, is advanced to the exit of the heart. Then, this tube is inserted into the coronary artery mouth and contrast dye is injected from its end. This injected dye fills the inside of the coronary artery, making it visible for the vessel. In this way, it is displayed whether there is a stenosis in the vein. The given contrast is then excreted by the kidneys.
The entire procedure usually takes less than half an hour, but sometimes it can take longer due to technical or patient-related issues. During the procedure, the patient’s vascular access is established and the heart rate and rhythm are monitored on the monitor.
If a decision is made to insert a stent during the procedure, the procedure time will naturally be prolonged. This extension may be of varying durations depending on the scope of the transaction.
After the procedure, the patient is kept in the hospital for several hours or sometimes overnight. During this time, it is recommended to drink plenty of water to remove the given contrast agent.
Before going home, the patient is shown how to control the procedure site bleeding and what to do if there is bleeding. In particular, patients who are operated on the groin are asked not to lift heavy weights for a week and not to stretch that leg.

What are Percutaneous Coronary Interventions?

Balloon angioplasty-stent and other procedures used to open coronary vessels by entering through a vein through the skin without surgery are called “percutaneous coronary intervention” (PCI). About 1/3 of coronary heart patients are treated with PCI.

Balloon Angioplasty Procedure

Coronary Balloon Angioplasty is a treatment attempt to open the narrowed or occluded vessel by continuing the procedure in the same session or in a later session for patients who have decided to apply a balloon to their diseased vessel as a result of coronary angiography. Balloon dilatation (balloon expansion) is performed in the cardiac catheterization laboratory by using catheters designed for this procedure, similar to the catheters used in the angiography procedure (thin long, soft plastic tubes).

The first part of the angioplasty procedure is similar to coronary angiography. Under local anesthesia, while awake, stenosis is removed by controlled inflation of a specially designed balloon in the stenosis area in the vessel. When the balloon is inflated, it pushes the plaques against the artery wall. After the balloon is removed, blood flow is restored from the occluded area. The procedure usually takes less than 1 hour and the patient who does not need long-term medication is usually discharged the next day.

Coronary Stent

Coronary stents have been developed to overcome some of the difficulties encountered in balloon treatment and to provide a better blood flow in the opened vessel and have been widely used since the 90s. Coronary Stent (steel wire cage) is a method used to eliminate these problems in patients whose coronary vessels cannot be opened adequately by balloon treatment and/or in patients with intravascular rupture after balloon operation. Stent; It is placed on the balloon and when the balloon is inflated in the vessel, it is mounted on the inner wall of the vessel. One or more stents may be required, depending on the length of the narrowed area. Within weeks, these stents are covered with an endothelial layer and the stent remains in the vessel wall for life. Over the years, technologically better quality stents have been made, and this intervention has somewhat reduced the need for By-pass surgery. The success rate in balloon and stent application is between 65-99%. Re-narrowing (restenosis) may occur with a probability of 20-30% within a six-month period. In newly introduced drug-coated stents, this probability has decreased to the range of 8-15%. In case of narrowing in the stent, the balloon or stent can be applied again. After stent placement, the patient can be taken to the coronary intensive care unit. The hospital stay is usually 1-2 days. It is very important to keep the treated leg straight for the first 6-12 hours after the procedure.

What is the Risk of Balloon Angioplasty and/*or Coronary Stent Procedures?

Every interventional procedure has a certain amount of risk. Balloon angioplasty and stenting have a low risk of complications (adverse events or outcomes).

Sudden vascular occlusion (acute occlusion) occurs with occlusion in the area treated with the balloon during the procedure and within the first 24 hours after the procedure. However, this risk is lower if a stent was inserted during angioplasty. Nonetheless, in cases with stent implantation, this risk continues until the 28th day, although it decreases gradually (Subacute occlusion). In order to minimize this risk, it is obligatory to use aspirin and other blood thinners recommended by the physician in people who have a stent implanted.

Most of the other complications are caused by sudden vascular occlusion: Heart attack (1-2%), Sudden death (less than 1%), Need for emergency bypass surgery (less than 1%).

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Coronary Angiography