Coronary catheterization
Coronary angiography is an angiography of the coronary arteries and thus a special form of x-ray examination, in which the coronary arteries are imaged. It is performed in the context of a cardiac catheterization. X-rays make an X-ray contrast agent is injected into the lumen of the coronary arteries via a cardiac catheter, visible. The recordings were made earlier today documented on film or video material on digital storage media.
Indication
It is used for diagnosis of morphological relations of the coronary arteries ( coronary arteries) and for localization of stenoses and their nature and extent. Coronary stenoses can be in the same session dilated with a balloon catheter (percutaneous transluminal coronary angioplasty, PTCA) and permanently held open with a stent. About a filling of the left heart with contrast medium, disturbances of the contraction process of the heart under fluoroscopy can visualize ( Lävokardiographie ).
The diagnostic coronary angiography is indicated in patients
- Who have developed an acute coronary syndrome
- Having a higher grade ongoing angina (CCS Class III and IV) to drug therapy
- Pectoris with pathological results of noninvasive studies, regardless of the severity of angina
- Have survived a sudden cardiac arrest or life- threatening irregular heartbeat (ventricular arrhythmias)
- With symptoms of chronic heart failure.
Assessment
To describe a bottleneck, the narrowing of the vessel cross -section ( stenosis ), the morphology of the narrowness and the still existing flow is used.
Stenosis
The degree of stenosis is a percentage of the no longer flowed through the lumen. Here, the longitudinal diameter, the cross-section is not specified. A constriction of the diameter of 75 % corresponds to the narrowing of the area of the cross section up to 90%, that is, only 10 % of the remaining lumen is passed through. In accordance with the recommendation of the American Heart Association usually following classifications are used.
Stenosemorphologie
In accordance with the recommendation of the ACC / AHA classification for the following description of bottlenecks is used:
Coronary flow ( TIMI classification)
After Thrombolysis in myocardial Infarction - Classification ( TIMI ) coronary flow in the vicinity of vessel occlusion or a narrow (stenosis ) is described semi-quantitatively.
Risks and Complications
Main article: Risks and complications of cardiac catheterization
The risks of coronary angiography are regarded as altogether default. An increase in risk caused by obesity, renal impairment, generalized arteriosclerosis, etc. The most common, but easily manageable in most cases complication is bleeding into the puncture site of the bar. In addition, problems may occur by using iodinated contrast media ( kidney damage, allergic reaction, derailment of hyperthyroidism, transient neurological problems). In rare cases it can also lead to tears of the coronary vessels with life-threatening bleeding into the pericardial sac ( cardiac tamponade ) and infarcts. Also strokes occur in very rare cases.