Coronary Angiography is an invasive diagnostic procedure used to visualize the coronary arteries—blood vessels that supply the heart muscle with oxygen-rich blood. The procedure is most commonly performed when there is a suspicion of inadequate blood supply to the heart muscle due to narrowing or blockage of a coronary artery, which may cause symptoms such as angina pectoris or myocardial infarction.
Based on the angiographic findings, a decision is made on further treatment—whether it will be limited to medication, require the placement of a coronary stent, or necessitate coronary artery bypass surgery (CABG). Coronary angiography is also performed as part of the preoperative evaluation in patients with other cardiac conditions requiring surgical or interventional treatment.
How Is the Procedure Performed?
The procedure is performed in a specialized angiography suite (cardiac catheterization lab), under sterile conditions and with both invasive and non-invasive monitoring of the patient's status. The patient remains conscious. The access site is typically either the wrist (via the radial artery) or the groin (via the femoral artery), both of which are treated with a local anesthetic.
A catheter is introduced into the artery and navigated through the arterial system to the aorta and coronary arteries. Iodinated contrast dye is then injected to visualize the arteries, which are recorded with X-ray imaging from multiple angles. The entire procedure, including preparation, takes approximately 30 minutes if uncomplicated, but may last longer in cases of difficult vascular access, arterial spasms, or anatomical abnormalities—none of which necessarily indicate complications.
Possible Complications
- Hematoma at the puncture site, which usually resolves within a few weeks
- Dissection of the access or coronary artery
- Pseudoaneurysms that may require surgical intervention
- Retroperitoneal bleeding
- Allergic reactions to contrast media
- Contrast-induced nephropathy
- Stroke
- Cardiac arrhythmias that may require emergency defibrillation
- Myocardial infarction
- Death
Hematomas are more common with femoral access. Although complications are rare, they are listed here for legal notice and general awareness.
Pre-Procedure Instructions at Home
If you are taking oral anticoagulants (e.g., Martefarin, Warfarin, Sintrom, Marcumar), stop them 3 days prior to the procedure in consultation with your physician. These medications must be replaced with a low molecular weight heparin (e.g., enoxaparin).
If you are taking Xarelto or Eliquis, take the last dose 24 hours before the scheduled procedure. No replacement therapy is necessary. Do not stop any anticoagulant therapy on your own initiative.
If you are already taking Clopidogrel 75 mg (Plavix, Zyllt, Clodil), do not discontinue it. If urgent percutaneous intervention is required, continued use of this medication is beneficial.
If you have diabetes, consult your doctor about insulin and oral antidiabetic medications.
Do not eat for at least 6 hours before the procedure. You may take your regular medications with water or tea at the usual time.
Please bring the following with you:
- Cardiologist’s reports
- Echocardiogram and stress test results
- Discharge summary if you were previously hospitalized
- Recent lab tests: CBC, potassium, urea, creatinine, AST, ALT, INR, blood type, Rh factor, and TSH
After the Procedure
If radial (wrist) access was used, a compression wristband will be applied and gradually released over the next 6 hours. During this time, mobility is limited to monitor for early reactions such as a sudden drop in blood pressure or heart rate.
If femoral (groin) access was used, the puncture site will be compressed with gauze and sandbags, and you will remain in bed for 8–10 hours or longer if necessary.
Notify medical staff immediately if you notice warmth, moisture, or bleeding at the puncture site, or if you experience chest pain, shortness of breath, dizziness, headache, ringing in the ears, abdominal pain, or pain in the limbs.
Instructions for Patients with Wrist Access:
- Mild numbness or discomfort in the arm for up to 3 days is normal. If you experience severe pain, contact your doctor.
- You may shower 24 hours after the procedure.
- Avoid straining or lifting with the affected arm for 5 days.
- You may drive 1 day after hospital discharge.
Instructions for Patients with Groin Access:
- A small bruise or hematoma at the puncture site is normal.
- When sneezing, coughing, laughing, or using the toilet in the first 2 days, gently press the puncture site.
- You may shower 1 day after the procedure.
- You may drive after 1 day.
Discharge
Most patients are discharged the day after coronary angiography. Before discharge, a physician and nurse will examine the puncture site. If there are no issues, you will receive a final report and discharge summary with recommendations for further treatment.
Keep the dressing on the puncture site for another 24 hours. Do not apply creams or lotions to the area. For the next 10–14 days, avoid physical strain such as cycling, swimming, sauna use, or gym workouts.
Contact Your Doctor If You Experience:
- A large, hard lump under the skin at the puncture site that is painful or restricts movement
- Change in color, numbness, or coldness of the limb
- Fever
- Bleeding at the puncture site
- Chest pain not relieved by prescribed therapy