What is Coronary Angiography?

Coronary Angiography is a specific term that simply means...
The Imaging of Coronary Arteries.

Here's how it breaks down.

The word Angio actually comes from the Greek word Angeio which means blood vessel or vessel. Graphy means the writing of...or representation in some manner...such as picture or audio format of a specific object...in this case, Coronary Arteries.

History

Heart Catheterization - the advancement and positioning of a flexible tube into one of the hearts chambers was performed by a Dr Werner Forssmann...a German physician...on himself!...using a urinary catheter. The year was 1929.

Prior to that date there had been some experimentation but unlike other efforts Dr Forssman actually used X-ray equipment to guide and position the catheter...documenting his efforts with a chest X-ray.

He was immediately fired for what seemed at the time like reckless experimentation...he did end up receiving a Nobel prize though in 1956. Some compensation perhaps.

Left Heart Catheterization...along with Coronary Angiography did not occur until the late 1950s with experimentation to selectively guide a catheter tip into the origins of the coronary arteries. The realization and potential was seen after an accidental occurrence...a catheter kind of just jumped in there!...as it was in the anatomical neighborhood!

A Cardiologist by the name of Mason Sones is credited with discovering and realizing the potential of selectively taking pictures of the Coronary Arteries and establishing a technique for others to follow...and the rest as they say is history!

Many technological advancements have been made between then and now, but essentially the procedure for Coronary Angiography remains the same.

In a nutshell

Coronary Angiography involves the introduction of a catheter...a small diameter plastic tube...into the arterial system. The catheter is advanced and manipulated under X-ray guidance into the origin(s) of the coronary arteries which open from the Aortic root...just above the Aortic valve (remember from your biology class!)

Once a catheter tip is sitting correctly in a coronary artery origin, a few milliliters of X-ray contrast media is pushed through the catheter and into the selected coronary artery. The contrast fills the coronary artery for a few seconds and moving X-ray pictures are acquired...recording a true real-time representation of the coronary artery.

Any coronary artery abnormalities such as a reduced diameter due to the build up of calcified plaque which is the process of atherosclerosis...and thrombus which is a blood clot can easily and immediately be assessed from coronary angiogram images.

Left Heart Catheterization involves a catheter tip engaging in the...

Left Coronary Artery system: Usually a single origin or opening about four millimeters in diameter off the left side of the Aortic Root

Right Coronary Artery: Usually a single origin of about three millimeters in diameter opening off the right side of the Aortic Root

Main heart pumping chamber or Left Ventricle:

Chamber or cavity accessed through the Aortic valve

Three different catheters of the same length and diameter...but with very different catheter tip shapes are utilized in a Coronary Angiogram procedure.

The three different shapes are necessary to assist the manipulation of the catheter tip into the correct position. Catheters can only be steered using forwards, backwards, clockwise and counter-clockwise movements...so of course some pre shaping at manufacture is hugely beneficial...along with a slick technique by the attending Cardiologist of course.

Here are a couple of still shots that show a single frame of a
Coronary Angiogram sequence.

Frame one shows the Left Coronary Artery system full of X-Ray contrast media. The arteries appear essentially normal. The extra dark areas of the arteries are points at which the arteries twist or kink...changing direction and creating a double layer effect of contrast media. You can just see the end of the catheter (top center left) in this shot but not the tip as it is hidden behind the arteries. Here's a still shot of the Right Coronary Artery. This artery usually has one main branch for most of its length terminating in a cluster of three or four branches..not visible in this image. During a Coronary Angiogram, the right coronary artery is the one that looks like a letter C or L whereas the left coronary arteries tend to look a bit like a set of spiders legs! There appears to be some very mild coronary disease throughout the length of this artery...note the slightly wavy, uneven appearance in the diameter of the artery as you look along its length. The wall of the artery can taper and curve but it must be smooth to be declared normal. This level of arterial disease would produce no symptoms at all.

...Here's an interesting question to finish with...

Does the presence of symptom-less disease mean that a person is well and healthy? ....more on this Click Here....

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