A coronary angiogram is an imaging study (almost like an X ray) used to study coronary arteries (arteries around the heart) with the purpose of checking for blockages or semi blocked arteries.
When blocked arteries are found the cardiologist will in most instances proceed to open these blockages in the same procedure. In about 5 to 10% of all cases, bypass surgery (and not stenting) will be the better option and the cardiologist will now refer the patient to a cardio thoracic surgeon for further management.
IS IT SAFE?
Yes, coronary angiograms are very safe procedures in the hands of competent and experienced operators. Complications can happen in any medical procedure but these are the absolute minimum.
HOW IS IT DONE?
This procedure is done in a specialised theatre called a Catheterisation laboratory. Our staff are highly specialised and trained individuals with many years of experience to ensure only the best and safest care.
There is no general anaesthesia involved and our patients are normally fully awake. Mild sedation is used to counter any anxiety. In most cases it is not a painful procedure.
After administrating local anaesthesia, access is gained via the right or left radial artery (wrist artery) in 95% of patients. In the remaining 5%, the procedure is done from the left or right femoral artery (groin artery).
A small plastic cannula is inserted (sheath) in the artery and a small specially designed plastic tube (diagnostic catheter) is passed through the cannula via the radial or femoral artery until the coronary arteries are reached.
An iodine based contrast media (dye) is used and injected through the catheter to fill the artery to be studied, while a dynamic X ray is taken at the same time. Once all the images are taken, the cardiologist will assess the findings and decide upon the best treatment strategy (should there be blockages or narrowed arteries).
If the study is normal – the patient will now be taken back to the ward to await discharge later on.
In the event that some of the arteries are stenosed (narrowed) and thus limiting blood flow to the heart muscle, the cardiologist will proceed to open the vessel by means of balloon angioplasty and stent procedure.
A stent is a highly specialised permanent metal structure (almost like a spring) that is inserted inside the artery at the area of the blockage and deployed to open the blocked vessel and to restore blood flow.
Stents can’t move or rust. They can re-occlude but this has become a rare occurrence in current times. Absolute care is taken to avoid closing of stents by adding appropriate medication designed specifically for this purpose.
Opening an artery by means of balloon angioplasty and stent procedure is a permanent and final treatment strategy and not a step to a bypass surgery later on or a delay of an inevitable bypass operation.
WHAT ARE THE POSSIBLE COMPLICATIONS ?
Post procedural pain at the side of access (wrist or groin) (adequate pain medication is available.)
Occlusion of the radial artery (normally treated conservatively.)
Tear in the femoral or radial artery – (in extreme cases requiring vascular surgical repair.)
Tear or rapture of the coronary artery with subsequent heart attack (specific treatment strategies exist to handle these conditions.)
Occlusion of the artery with subsequent heart attack (specific treatment strategies exist to handle these conditions.)
Cardiac arrhythmia requiring DC (electrical shock) cardioversion.
Worsening of failure due to contrast media (special precautions are taken pre-operatively to avoid this and specific treatment strategies exist to handle these conditions.)
Closure of an inserted stent with subsequent heart attack (specific treatment strategies exist to handle these conditions.)
WHEN CAN I GO HOME?
Patients who have had angioplasty and stent procedures will have to stay over for at least one or 2 nights after their procedure.