Coronary angiography is an exploration technique used in cardiology which makes it possible to precisely visualize the state of the coronary arteries.

Coronary angiography is a medical imaging examination requiring the injection of a contrast product, opaque to X-rayswhich will make possible the visualization of all coronary arteries that surround the heart.

Although this examination is particularly invasive (since it involves the puncture of an artery), it is usually painless and does not require general anesthesia. It is practiced in a confined and surgical atmosphere.

The coronographie is used in case of cardiac signs (such as chest pain) in patients with cardiovascular risks. It allows to observe the evolution of atherosclerosisin these patients. Indeed, over time, calcified fatty deposits (called atherosclerotic plaques) accumulate in the coronary arteries threatening to obstruct their passage by reducing the flow of blood.

In 40% of cases, coronary angiography results in a revascularization procedure (angioplasty with stenting or coronary aorto bypass).

Coronary angiography allows the screening for coronary artery disease essentially obstructive. Over the years, atherosclerotic plaque settles on the walls of our arteries. Associated with cardiovascular risk factors, it will narrow (stenose) the lumen of the arteries (atherosclerosis). The coronary arteries are largely involved in this process.

The stenosis, when it reaches a certain degree of importance, can give rise to a typical pain in the thorax called anchor or angina. In addition, coronary occlusion by plaque rupture or thrombosis results in acute coronary syndrome and leads to myocardial ischemia (myocardial infarction).

At the end of the examination, the doctor has two therapeutic options: medical treatment or revascularization of the myocardium by coronary angioplasty with stenting or by coronary artery bypass grafting.

Here is the list of indications for performing coronary angiography:

• typical chest pain (angina pectoris) or atypical in patients with cardiovascular risk factors;
• myocardial infarction. In this case, coronary angiography is performed urgently;
• acute coronary syndrome without ST-segment elevation (diagnosis frequently mentioned in the emergency department. Risk of progression to myocardial infarction, heart failure and death);
• positive or doubtful myocardial ischemia tests (stress test, myocardial scintigraphy, etc.);
• unstable angina crisis (chest pain that comes from an acute obstruction of a coronary artery without myocardial infarction. It is generally intense, present at rest and resists taking trinitrine);
• recurrence of angina following coronary angioplasty (suspicion of restenosis) or heart bypass surgery;
• picture suggestive of spastic coronary disease or Prinzmetal’s angina (usually in young subjects and smokers). Prinzmetal’s angina is a violent, prolonged and spontaneous chest pain, caused by a sudden decrease in coronary flow secondary to an arterial spasm, most often on arteries already narrowed by an atheroma plaque;
• unexplained heart failure;
• heart rhythm disorders (tachycardia or ventricular fibrillation);
• a pre-operative assessment before valvular surgery in patients aged over 40, surgery for congenital heart disease or major surgery (vascular surgery such as resection of an AAA, etc.).

THE angina symptoms are an indication for coronary angiography. Symptoms include:

• a sharp chest pain ;
• numbness or lack of sensation in the arms, shoulders, wrists;
• a constant feeling of indigestion that ranges from moderate to intense;
• a dull, radiating pain that begins in the middle of your chest and extends to your neck, back, throat, jaw, and/or left arm;
• a feeling of vice, tightness in the chest or arm.

These signs most often appear following physical exertion or emotional stress, but they can be felt at rest. If these manifestations appear, you should:

• take your prescribed medications if you are already being treated for angina pectoris. If your medication does not improve your condition quickly, call 15 or 112.
• call 15 or 112, if you are not already being treated for angina pectoris. Do it quickly, even if the pain does not have the characteristics described above (atypical chest pain).

Coronary angiography is not possible in the following cases:

• chronic or acute renal failure;
• fever ;
• stroke or TIA;
• anemia;
• history of iodine anaphylactic shock;
• absence of an approach (when the operator is unable to puncture the femoral, radial or even humeral arteries).

Before the exam, you should:

• report any contraindication or allergy to iodine during the systematic preliminary examination;
• carry out certain clinical and biological examinations, the results of which must be presented on the day of the exploration;
• stop taking any oral anticoagulant treatment which will be replaced by its injectable form;
• take prescribed medications to prepare for the exam (such as a sedative);
• do not eat or drink (fasting) for at least four hours before the exam.

The exam takes place at operating room (or in specially equipped radiology room). The patient lies comfortably on the examination table, arm rests relieve the upper limbs which remain alongside the body throughout the examination. The patient is warmly covered until the last moment of the exploration.

The patient is monitored throughout the examination by means of an electrocardiogram monitoring, a pulse oximeter placed at the end of a finger, a blood pressure measurement armband.

The anesthesia is local, and a slight medicinal anxiolysis can be performed in the most distressed people.

To reach the entrance to the coronary arteries, the preferred approach is that of the radial artery (at arm level), or the femoral artery (at the thigh). It is the caliber of the arteries that determines which technique to use.

A small incision is made to access the femoral or radial artery. A file guide is then inserted into the artery and threaded through the aorta. A catheter is then inserted along the guide wire. When the catheter reaches the aorta, a contrast agent is injected. When the dye passes from the aorta to the coronary arteries, an x-ray or angiography is done. The image acquired during angiography indicates the possible presence of blockage(s), aneurysm(s), narrowing(s) or any other abnormality in the arteries. At the end of the angiography, the catheter and the guidewire are removed.

If necessary, the doctor can recommend the appropriate treatment. The examination can lead to a treatment of the narrowing in the wake, by coronary angioplasty, thus avoiding a new hospitalization.

Coronary angiography is a invasive examination but almost painless. The exam only lasts 20 to 30 minutes.

After the operation, the patient can get up more or less quickly depending on the method used (when it is the femoral artery that has been incised, it is recommended to remain in a lying position longer to avoid bruising).

Coronary angiography can be performed on an outpatient basis. But most of the time it requires a day hospitalization or even 24 to 48 hours before returning home.

The patient is encouraged to drink plenty of fluids following the procedure to flush out the contrast product. He is not allowed to drive to return to his home. It is advisable to take it easy the days following the exploration (no sport or heavy lifting). Finally the date of back-to-work should be discussed with the doctor.

The possible complications of coronary angiography are generally benign:

• risk of radial artery thrombosis;
• risk of hematoma of the axillary hollow at the level of the femoral artery.

The risk of serious complications is rare, the risk of death is estimated between 1 in 1000 and 1 in 2000 examinations.