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The role of Coronary Angiography in the diagnosis of heart disease

Coronary Angiography left coronary arteryCoronary artery disease (CAD) is a condition characterized by narrowing of the coronary lumen after the formation of atheroma plaques. This induces a decrease of oxygenated blood supply to the corresponding myocardial territory. The consequence of myocardial ischemia is impaired normal function of the heart muscle.

Coronary angiography is an invasive investigation, non-surgical, which brings the most accurate information about the characteristics of coronary stenosis, the number of affected vessels and is needed to determine later optimal treatment: only medical treatment, interventional coronary treatment (coronary angioplasty, coronary stent implantation) or surgical coronary revascularization. Can also be highlighted: anatomic variants, coronary spasm, myocardial muscle bridges, coronary fistula, coronary dissection, coronary abnormalities in inflammatory diseases or complex congenital disorders. In subocclusive or occlusive stenosis is assessed inter or intracoronary collateral circulation. The angiographic appearance of stenosis can bring qualitative information about lesion: calcification, thrombosis.

cardiac catheterization laboratoryCoronary angiography indications include the following situations, with different degrees of priority or urgency in some cases:

  • patients with coronary artery disease if the medical treatment is not effective and there is a recurrence or worsening angina;
  • novo angina, unstable angina, myocardial infarction, angina after infarction;
  • patients without anginal pain, but with ECG changes;
  • patients with symptoms suggestive of CAD, but with inconclusive ECG;
  • assessment of coronary vessels after interventional procedure or after aortocoronary bypass intervention;
  • patients with valvular heart disease or congenital heart malformations that are suspected to have coronary disease.

Consequence of performing coronary angiography is the establishment of optimal treatment. Depending on the number of stenoses, the number of affected vessels, appearance and characteristics of lesions, patient age, associated diseases, treatment option can be chosen: medical, interventional or surgical.

If there are lesions which meet the criteria for coronary interventional procedures (PCI), coronary angioplasties are performed with implantation of bare metal coronary stents or pharmacologically-active stents or used other interventional techniques (rotational devices, intracoronary administration of an adjuvant medication). Depending on the selection of cases, the supplies available and team experience may also be considered complex lesions, with severe multivessel lesions. In general, the risk of major complications is low, less than 0.01%, and obviously, depends on the complexity and number of lesions treated, number of affected vessels, associated diseases.

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