Diagnostic coronary angiography is a minimally invasive method through which the diagnosis of coronary artery disease is established.

It is the ultimate diagnostic tool for determining the subsequent treatment of coronary artery disease, either in the form of revascularization and/or the initiation of medication with the administration of antiplatelet and antianginal drugs with the aim of treating angina symptoms and preventing a possible future myocardial infarction.

Coronary artery disease is the most common cause of death worldwide, with approximately 17,000,000 people dying each year from this disease.

With diagnostic coronary angiography and the additional diagnostic tools that accompany it, such as intravascular imaging and the quantitative assessment of the coronary blood flow of the heart’s vessels, the diagnosis of coronary artery disease is absolutely accurate, unquestionable and allows the precise determination of the corresponding treatment .

The method is minimally invasive and usually involves puncturing the artery in the arm (femoral artery) or leg (femoral artery) after administration of a local anesthetic (in the majority of cases, >99%, coronary angiography is performed manually).

Through the use of ultrasound guidance, the puncture is absolutely precise, while at the same time the risk of complications, such as bleeding and hematoma, is eliminated. In addition, the evolution in the technology of the materials used has made diagnostic coronary angiography a fast, painless and completely safe method in the diagnosis of coronary artery disease (the risk of complications is less than 0.1%). Carrying out the examination by hand allows the immediate mobilization of the patient immediately after the end of the operation, leaving the hospital on the same day, while the patient becomes fully functional and can return to work even the next day without special restrictions even after stent placement.

The duration of the examination is approximately 20 minutes during which the coronary arteries that supply blood to the heart are visualized through fluoroscopy and selective contrast administration, through special catheters. With the use of additional diagnostic methods, such as endovascular imaging and assessment of coronary physiology and blood flow, the duration of the examination reaches 60 minutes.

Diagnostic techniques during coronary angiography

1) Intravascular imaging techniques

Intravascular imaging techniques such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) allow accurate qualitative and quantitative analysis of the atherosclerotic plaque causing the stenosis within the vessel by determining plaque composition and total burden of the plaque and in addition the anatomical severity of the stenosis by determining the area of ​​the free lumen of the vessel at the point of the stenosis.

2) Intracoronary blood flow determination techniques

With these techniques, it is possible to determine with extremely high precision the impact that the narrowing within the vessel has on the blood flow, i.e. the percentage reduction (%) in the blood flow due to a specific narrowing. If the reduction is more than 20%, the stenosis is classified as hemodynamically significant, causing ischemia in the heart under stress conditions and should be treated with stenting usually.
It is the most objective and accurate method of determining the degree of ischemia of the heart with a diagnostic accuracy rate of over 95%, while it is the only method that allows the determination of the degree of ischemia caused by each stenosis separately.

The most widespread and used method is fractional flow reserve (FFR) which involves the entry of a special guide wire beyond the point of stenosis and the intravenous administration of a special drug to induce drug stress. The duration of the test is approximately 2 minutes during which symptoms are caused due to the induced hyperemia, such as headache, burning in the chest, shortness of breath, palpitations, which disappear immediately within a few seconds after stopping the drug.

In addition, with this specific test, it is possible to assess the function of the small vessels of the heart (microscopic size – they cannot be distinguished by simple coronary angiography), and to diagnose microvascular disease in patients without significant stenoses in the large vessels but with symptoms of angina pectoris.
The indicators evaluated include the coronary flow reserve (CFR) ie how many times the heart can increase the total blood flow to the myocardium and the index of microcirculatory resistance (IMR).

In addition, it is possible to estimate coronary blood flow using techniques that do not involve drug administration at rest without inducing hyperemia and thus accompanying symptoms (headache, chest burning, dyspnea, palpitations).