Revising Medical Author: Dennis Lee, MD
Revising Medical Editors: Daniel Kulick, MD, William C. Shiel, Jr, MD, FACP, FACR

• What is a coronary angiogram?
• How is a coronary angiogram performed?
• What does a coronary angiogram demonstrate?

What is an angiogram?

An angiogram is simply an x-ray image of blood vessels after they are filled with a contrast material. A coronary angiogram is the "gold standard" for the evaluation of coronary artery disease (CAD). A coronary angiogram can be used to identify the exact location and severity of CAD.

How is a coronary angiogram performed?

Coronary angiography is performed with the use of local anesthesia and intravenous sedation, and is generally not terribly uncomfortable. During a coronary angiogram, a small catheter (a thin hollow tube with a diameter of 2-3 mm) is inserted through the skin into an artery in either the groin or the arm. Guided with the assistance of a fluoroscope (a special x-ray viewing instrument), the catheter is then advanced to the opening of the coronary arteries, the blood vessels supplying blood to the heart. Next, a small amount of radiographic contrast (a solution containing iodine, which is easily visualized with x-ray images) is injected into each coronary artery. The images that are produced are called the angiogram.

The procedure takes approximately 20-30 minutes. After the procedure, the catheter is removed and the artery in the leg or arm is either sutured, "sealed," or treated with manual compression to prevent bleeding.

What does a coronary angiogram demonstrate?

Angiographic images accurately reveal the extent and severity of all coronary artery blockages. For patients with severe angina or heart attack (myocardial infarction), or those who have markedly abnormal noninvasive tests for CAD, the angiogram also helps the doctor select the optimal treatment, which may include medications, balloon angioplasty, coronary stenting, atherectomy ("roto-rooter"), or coronary artery bypass surgery . The coronary angiogram is the only test which allows the precise quantification of the extent and severity of CAD to optimally make these treatment decisions. In appropriate patients, the therapeutic information learned from the angiogram is far more valuable than the relatively small risk of the procedure. There is a small risk of serious complications from coronary angiography, as it is an "invasive" test, but in the hands of experienced physicians, this risk is quite small (well below one per cent).

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