Coronary angiography:The most accurate method (the "gold standard") for evaluating and defining coronary artery disease (CAD). Coronaryangiographyis used to identify the exact location and severity ofCAD.
During coronaryangiography, a smallcatheter(a thin hollowtubewith a diameter of 2-3mm) is inserted through theskininto anarteryinthegroinor thearm. Guided with the assistance of a fluoroscope (a specialx-rayviewing instrument), the catheter is then advanced to the opening of thecoronary arteries,bloodvessels supplying blood to the heart. Next, a small amount of radiographiccontrast(a solution containingiodine, which is easily visualized with x-ray images) is injected into each coronary artery. The images that are produced are called the angiogram. Angiographic images accurately reveal the extent and severity of all coronary arterial blockages.
Coronary angiography is performed with the use of localanesthesiaandintravenoussedation, and is generally not terribly uncomfortable. The procedure takes approximately 20-30 minutes. After the procedure, the catheter is removed and the artery in thelegor arm is sutured, "sealed," or treated with manualcompressionto prevent bleeding. There is a small risk of serious complications from coronary angiography, as it is an "invasive" test, but in the hands of an experiencedphysician, this risk is quite small (well below one per cent).
In patients for whom the test is appropriate, thetherapeuticinformation learned from the coronary angiogram is far more valuable than the relatively small risk of the procedure. For patients with severe angina or myocardial infarction, or those who have markedlyabnormalnoninvasive tests for CAD, the angiogram also helps thedoctorselect the optimal treatment, which may include medications,balloon angioplasty, coronary stenting,atherectomy("roto-rooter"), or冠状动脉旁路手术surgery.
The coronary angiogram is the only test which allows the precise quantification of the extent and severity of CAD to optimally make these treatment decisions.
