Coronary Angiography
Coronary angiography is a minimally invasive technique used for the detection and management of coronary artery disease (CAD). The procedure is performed through detailed radiological (X-ray) imaging following the injection of contrast medium into the coronary arteries, to study their anatomy and identify potential stenoses resulting from the development of atherosclerotic plaques.
It allows the assessment of the hemodynamic significance of any detected stenoses (i.e., whether they significantly impair myocardial perfusion) and the evaluation of the extent of atherosclerotic disease, even in segments without overt narrowing. The examination assists in determining the optimal therapeutic plan, which may include intensive medical therapy, percutaneous coronary intervention (angioplasty), or coronary artery bypass grafting (CABG).
In modern catheterization laboratories, invasive coronary angiography is considered a safe procedure, with a very low incidence of life-threatening complications. Currently, coronary angiography can be performed invasively via the radial or femoral artery approach, or non-invasively using computed tomography (CT). However, CT coronary angiography does not yet provide the same imaging resolution as invasive coronary angiography and does not permit immediate intervention in the presence of critical coronary occlusions.
When other diagnostic tests, such as exercise stress testing, echocardiography, or stress echocardiography, suggest the possible presence of coronary artery disease, coronary angiography is the diagnostic modality of choice. It is also indicated in patients presenting with chest pain of unknown origin who have undergone non-invasive cardiologic testing with inconclusive results, to confirm or exclude CAD. Furthermore, coronary angiography is performed in the evaluation of heart failure of unknown etiology, after successful resuscitation from cardiac arrest, or in the presence of life-threatening cardiac arrhythmias. It is also used to assess suspected coronary anomalies or complex congenital heart disease, as well as to exclude CAD in cases of newly developed heart failure or cardiomyopathy.
An absolute indication for coronary angiography is the occurrence of acute myocardial infarction, in order to identify the culprit lesion—usually a coronary artery occlusion—and to enable immediate percutaneous coronary intervention (angioplasty) for revascularization.
Percutaneous Coronary Angioplasty
Interventional cardiology has introduced new perspectives into cardiovascular medicine through minimally invasive techniques for both the diagnosis and treatment of various cardiac diseases. Over time, major advances have been achieved in interventional cardiology, including the development of new techniques and devices. These innovations have improved patient outcomes, procedural safety, and expanded the scope of therapeutic interventions.
Percutaneous coronary interventions (PCI), commonly known as angioplasty, constitute the cornerstone of interventional treatment for coronary artery disease. This approach restores blood flow in arteries acutely or chronically occluded due to atherosclerotic plaque deposition, thereby preserving myocardial perfusion. The use of interventional cardiology techniques can, in many cases, obviate the need for surgical revascularization via coronary artery bypass grafting (CABG).
Stents are widely used in interventional cardiology to restore blood flow in stenotic or occluded arteries. Recent advancements have focused on improving stent design, resulting in scaffolds with thinner struts and greater flexibility. Moreover, newer drug-eluting stents (DES) are coated with pharmacological agents that are gradually released after deployment at the target lesion site, effectively reducing the risk of restenosis.
Like all invasive procedures, coronary angioplasty carries a risk of complications; however, with proper pre-procedural planning, adequate lesion preparation, and the operator’s experience, these risks are markedly minimized. Periprocedural complications include hematoma or bleeding at the puncture site and, more rarely, acute myocardial infarction, occurring in less than 2% of cases. Post-procedural complications may include restenosis at the site of intervention, which depends on the patient’s comorbidities and the complexity of the procedure. Stent thrombosis, leading to myocardial infarction, is exceedingly rare and typically results from poor patient adherence to medical therapy, particularly premature discontinuation of antiplatelet therapy before the recommended duration.
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