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Coronary angiography: procedure, angioplasty and precautions

Coronary angiography is an invasive examination that directly visualises the coronary arteries using a catheter and iodinated contrast. It is performed in a hospital or specialist clinic, not at the practice. Its indication depends on symptoms, risk and previous investigations.

When is it proposed?

It may be needed urgently for an acute coronary syndrome. Outside emergencies, it may be discussed for a high probability of coronary disease, severe symptoms despite treatment, a high-risk non-invasive test or when revascularisation is being considered.

What happens during the procedure?

After local anaesthesia, the cardiologist introduces a catheter, usually through the radial artery at the wrist and sometimes through the femoral artery in the groin. Contrast injection reveals narrowing or blockage. A temporary warm sensation may occur. The patient usually remains awake.

Angiography and angioplasty

Angiography establishes the anatomical diagnosis. If a lesion warrants it and the strategy has been discussed, balloon angioplasty and stent implantation can sometimes be performed during the same procedure. Not every narrowing needs a stent: an intracoronary functional measurement or medical treatment may be preferred.

Preparation

The centre gives fasting instructions. Report kidney impairment, a previous reaction to iodinated contrast, recent bleeding and all medicines, especially anticoagulants, antiplatelets and diabetes treatments. Do not change any treatment without the team's advice. Recent blood tests, including creatinine, are often needed.

Possible risks

The most common complications are bruising or bleeding at the puncture site. Contrast reactions, worsening kidney function or arterial complications are also possible. Arrhythmias, heart attack, stroke or death are rare but explain why this procedure requires a specialist setting.

After the procedure

Monitoring and compression of the puncture site are needed. Instructions on fluids, restarting medicines, activity and dressings depend on the access site and any angioplasty performed. Chest pain, persistent bleeding, significant swelling or a cold hand requires urgent advice.

For persistent chest pain or faintness, call 15 in France.

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