What is diagnostic coronary angiography?
Diagnostic coronary angiography is the standard diagnostic method for evaluating the coronary arteries and accurately diagnosing coronary artery disease. It is considered the “gold standard” in cardiology for the diagnosis and assessment of coronary artery stenoses.
Thanks to additional diagnostic methods that can be applied during coronary angiography, such as intravascular imaging techniques (IVUS and OCT) and functional assessment of the coronary arteries using FFR/RFR/iFR/CFR/IMR, it provides unique and nearly absolute accuracy in analyzing and evaluating the coronary arteries that supply blood to the heart.
How is the diagnostic coronary angiography procedure performed?
The diagnostic coronary angiography procedure involves the use of a special catheter inserted through the radial artery (wrist) or femoral artery (leg) and advanced to the heart. Through this catheter, contrast dye is selectively injected into each of the coronary arteries responsible for supplying blood to the heart. This dye enables the visualization of the coronary arteries through fluoroscopic images and highlights chronically occluded arteries.
The contrast medium facilitates high-resolution, real-time imaging of the coronary arteries, revealing the anatomical condition of the vessel lumen. These images allow for the precise evaluation of the presence of stenosis, occlusion, or other abnormalities that may obstruct blood flow to the heart.
During coronary angiography, the patient remains awake with mild sedation, and local anesthetic (lidocaine) is injected intradermally at the puncture site to reduce the discomfort of the needle during arterial access. Additionally, in radial access, a vasodilator—usually verapamil—is administered into the radial artery, which may cause a burning sensation in the arm lasting approximately 30 seconds that then fully subsides.
Coronary angiography is used not only for diagnostic purposes but also for therapeutic interventions. If stenoses or occlusions are identified, immediate intervention such as balloon angioplasty or stent placement may be performed to restore normal blood flow.
The examination is typically minimally invasive, performed in the vast majority of cases through radial artery access from the wrist, allowing patients to be discharged from the hospital the same day without the need for overnight stay.
After the procedure, hemostasis devices are applied: a hemostatic bracelet on the wrist (TR band containing an air chamber from which air is gradually removed) that remains in place for a few hours before being removed, and a bioresorbable plug (AngioSeal) at the femoral artery in the leg, which is absorbed within 3 months.
Although diagnostic coronary angiography provides accurate and detailed data, the decision to use it depends on the patient’s overall condition, clinical presentation, and symptoms.
How long does coronary angiography take?
The coronary angiography procedure usually lasts around 20–30 minutes. However, the total duration of the hospital visit may be longer, including preparation time, the procedure itself, and the post-procedure recovery and monitoring period.
When is diagnostic coronary angiography performed?
Diagnostic coronary angiography is performed in various situations, primarily when there is strong suspicion of underlying coronary artery disease, to assess the condition of the coronary arteries and guide the appropriate treatment strategy. The main indications include:
Symptoms of coronary artery disease: anginal symptoms such as chest pain, tightness, heaviness in the chest, and shortness of breath.
Detection of coronary disease and stenosis on coronary CT angiography.
Acute myocardial infarction.
Cardiac arrest.
Malignant cardiac arrhythmias, such as ventricular tachycardia.
Preoperative evaluation before invasive cardiac surgery.
Evaluation of the effectiveness of previous treatment, such as the patency and placement of previous stents or bypass grafts, often using intravascular imaging techniques (IVUS/OCT).
The decision to perform angiography is made by the cardiologist based on the patient’s clinical symptoms, results from other diagnostic tests, and overall clinical presentation.
Are there complications after coronary angiography?
Yes, as with any medical procedure, coronary angiography may involve certain complications, although serious complications are relatively rare (<1/1000). Potential complications include:
Allergic reactions: Patients may develop allergic reactions to the contrast dye used during the exam. These reactions can be mild (e.g., rash or itching), but in rare cases may be severe (e.g., anaphylaxis).
Complications from catheter insertion: Catheterization may lead to vascular injury or bleeding and hematoma at the puncture site, either at the wrist or groin.
Cardiovascular complications: If injury occurs during the procedure—such as occlusion, embolism, or dissection of a coronary artery—complications such as arrhythmias, chest pain, shortness of breath, myocardial infarction, or cardiac arrest may arise. However, these events are extremely rare and usually managed immediately by the interventional cardiologist.
Stroke: An extremely rare complication that may result from catheter-induced vascular trauma and embolism of atherosclerotic debris, thrombi, or air bubbles.
Kidney injury: The contrast dye contains iodine, which may impair kidney function, especially in patients with pre-existing renal disease. Though rare, this requires monitoring of kidney function before and after the exam.
Despite the above-mentioned and extremely rare complications, coronary angiography is generally a safe and relatively painless procedure with exceptionally high diagnostic value and success rates.
Where can the procedure be performed?
Diagnostic coronary angiography can be performed in specialized medical centers equipped with the necessary infrastructure and technology. The procedure is carried out in catheterization laboratories located within hospitals or clinics, equipped with modern fluoroscopic systems, catheters, guide wires, balloons, stents, and devices for intravascular imaging and functional coronary assessment.
The choice of facility depends on the patient’s needs, the urgency of the case, and availability of services. Your cardiologist will guide you to the appropriate center or hospital, ensuring that you receive the proper care and support for the procedure.
What is the cost of diagnostic coronary angiography?
The cost of diagnostic coronary angiography can vary significantly depending on the clinic or hospital performing the procedure and the healthcare system in use.
Consult interventional cardiologist Dr. Andreas Kalogeropoulos for accurate pricing and insurance coverage information before undergoing the examination.
