CT Coronary Angiogram (cont.)
How is CT coronary angiogram performed and what are the risks of the procedure?
This procedure use intravenous dye which contains iodine and CT scanning
to image the coronary arteries. While the use of catheters is not necessary
(thus the term "noninvasive" test applies to this procedure), there are still
some risks involved. In people allergic to iodine, pretreatment with medications
is necessary to prevent allergic reactions to the dye. In people with abnormal
kidney function and/or diabetes, the dye may worsen kidney function. Finally,
there is radiation exposure which is similar to, if not greater than, that
received with a conventional coronary angiogram. Nonetheless, this is generally
a very safe test for most people, but should only be undergone when ordered by a
physician familiar with the patient and their underlying medical condition.
Who should get a CT coronary angiogram?
While CT angiography should not be used as a "screening"
test in the general population, it is a major new tool in the diagnosis of
coronary artery disease.
In patients at high risk for developing coronary disease (cigarette smokers,
those with genetic risk, high cholesterol levels, hypertension, or
diabetes), who have unclear results with treadmill or other testing, or who have
symptoms suspicious of coronary disease, CT angiography is an excellent next
step in the diagnosis. If the CT scan is normal or only mildly abnormal, it
makes the likelihood of a severe blockage of the coronary arteries
extraordinarily small. Conversely, if the CT scan is significantly abnormal,
cardiac catheterization and angiography are then indicated, to see if
angioplasty,
stenting,
or coronary bypass surgery may be indicated.
In people who have had bypass surgery, CT angiography is
very effective at evaluating the patency of the bypass grafts. In people who
have had coronary stents
, it is sometimes difficult to image the inside of the
stent to see if it is narrowed. Due to these complexities, while CT coronary
angiography is an
exciting new modality, it is imperative to discuss with your physician if this
is the correct test for you. As more experience is obtained, the indications for
the test will become even clearer.
Last Editorial Review: 1/10/2007
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