A coronary angiogram is a procedure performed by a trained cardiologist.
The coronary arteries are small muscular tubes that surround the heart and provide blood flow to it. The heart is a very active organ and requires almost continuous blood flow. A coronary angiogram is designed to check these heart arteries and make sure they are free of blockages.
The procedure is usually performed through a small artery in the wrist but can be performed from the artery in the groin in certain situations. An iodine based dye is used.
Approximately 90% of my coronary angiograms are performed through the wrist. 10% are performed via the artery in the groin. I will explain which is suitable for you and why.
There is very little pain associated with an angiogram. Hence they are performed with local anesthetic and only light sedation. A General anesthetic is only rarely needed.
I do not require patient to fast prior to their angiogram. A light breakfast and usual medications are fine.
There are few
I will usually follow on by implanting a stent immediately if I feel an equivalent or better result is obtainable with stents over bypass surgery. If it is a borderline case or surgery is clearly better, I tend to stop so that we can discuss the best strategy moving forward. I always like patients to be in control of decisions relating to their health care.
A coronary stent is a metal scaffold that is deployed within a coronary blockage to open the artery and restore normal blood flow. The usual procedure is as follows:
1. The artery is wired with a special coronary guide wire
2. The blockage is usually prepared prior to stenting with a gentle balloon inflation
3. The stent is deployed within the blockage
4. A final balloon within the stent to ensure it is optimally expanded
There are three major types of stents
1. Bare metal stents
2. Drug eluting metal stents
3. Dissolvable scaffolds
Each stent has advantages and disadvantages. One stent may be excellent in one clinical situation but a disaster in another. Drug eluting stents have a lower rate of renarrowing overtime compared to bare metal stents especially in patients with diabetes or narrow calibre coronary arteries (less than 2.75 mm in diameter). However, drug eluting stents require a minimum of 12 months of blood thinners. Bare metal stents require only 4 weeks. Dissolvable scaffolds are an evolving technology.
This means most surgical procedures will need to be delayed for at least 6 months. If delaying surgery is not an option, a bare metal stent remains the best option for you.
Fractional Flow Reserve or FFR
What is it?
A pressure assessment of a coronary narrowing that gives much more information than a % narrowing
Why is it so useful?
Determines who will benefit from a stent and who will not.
Who should have this performed?
Any person with a 50-70% coronary narrowing, to determine if a stent is indicated
Who shouldnt have this performed?
Suitable for almost all patients. AVOID CAFFEINE 24 HOURS PRIOR
Why would I have a narrowed coronary artery and a normal FFR?
The percentage narrowing is an visual estimation of the coronary blockage. It doesnt give any information about whether blood flow is actually reduced to the heart muscle. Very small arteries may have a very signifcant narrowing e.g. 90% but only a supply a very small part of the heart muscle. These would have a high percentage narrowing and a normal FFR and should not be treated.
What if I have a narrowed coronary artery and the FFR is negative?
These artery should not be stented. The five year risk of heart attack is very low and the risk of stenting outweighs the benefit for most patients.
What is it?
Rotational atherectomy is a highly specialised catheterization procedure to remove plaque within a blocked or narrowed artery due to a large amount of calcium build up. This is usually performed when balloon angioplasty is not possible or suitable to open up a blocked artery. Rotational atherectomy uses a revolving instrument called a Rotablator to break up calcified plaque clogging a coronary artery in order to restore blood flow to the heart. I offer this service as part of complex coronary intervention to suitable patients.
How it works?
Rotational atherectomy involves navigating a catheter fitted with a Rotablator device (diamond coated burr) through the site of the blockage, where it gently pulverizes the blockage into tiny particles that can pass safely through the bloodstream (particles smaller than red blood cells). Angioplasty and stenting are often performed after rotational atherectomy to improve the results and prevent the artery from re-narrowing.
Why it’s done
As you age your arteries can become clogged from build up of cholesterol plaques and calcium reducing blood flow to heart muscle. This narrowing of the arteries can cause a number of serious heart problems, including:
Rotational atherectomy to clear (or debulk) a narrowing artery facilitates balloon angioplasty and stent placement. The procedure can also be used to treat narrowing in the arteries that supply your limbs.
Who Should Perform Rotational Atherectomy?
Extensive training is crucial to the safe implementation of rotational atherectomy. Not all cardiologists can or should be performing this procedure. Watching this procedure is NOT the same as doing it with ones own hands. Being trained by some of Australia's most experience nterventional cardiologists with rotablator (Dr David Ramsay, Dr James Weaver, Dr Mark Sader), I have obtained a high level of practical experitse in this technique.
Always check the credentials and competency of any cardiologist performing this highly specialised procedure.