Coronary Angiography

A coronary angiogram is offered to find out whether narrowings in your heart arteries are the cause of your symptoms — such as chest pain, tightness or breathlessness — or following an abnormal result on another test, such as a CT scan, stress test or ECG. It may also be needed before valve surgery or TAVI, where the heart arteries must be assessed first.

If your likelihood of coronary disease is lower, we will often recommend a non-invasive CT scan first (a CT coronary angiogram). If this is clear, an invasive procedure has been avoided altogether. If it shows a narrowing that may need treatment, we then arrange invasive angiography — with the advantage that any significant narrowing can usually be treated at the same sitting.

Coronary angiography is the gold-standard test for identifying narrowings in the coronary arteries. It involves inserting a long, thin tube, called a catheter, through an artery in your wrist (radial artery) or occasionally at the top of your leg (femoral artery). Local anaesthetic numbs the area, and sedation is available to help you feel relaxed during the procedure.

The catheter is guided under X-ray until it reaches your heart. A contrast dye is then injected into each heart artery, showing the position, size and severity of any narrowings or blockages. The test itself usually takes 20–30 minutes.

We perform the vast majority of angiograms through the wrist rather than the groin. The radial approach is more comfortable, allows you to sit up and walk almost immediately afterwards, and substantially reduces the risk of bleeding.

This is reassuring news, and the procedure finishes at that point. We may then arrange other tests to establish the cause of your symptoms, and we will discuss preventive treatment to keep your arteries healthy.

In most cases, a significant narrowing can be treated immediately by angioplasty and stenting (PCI) during the same procedure — avoiding a second admission. We will have discussed this possibility with you beforehand so you can consent in advance. Where a narrowing is of uncertain significance, we use pressure-wire measurements during the angiogram to establish whether it is truly restricting blood flow, so you are only treated if treatment will genuinely help. Occasionally, the findings favour bypass surgery, in which case we will discuss the options with you and refer you to a cardiac surgeon through the Heart Team.

You can read more on the dedicated coronary angioplasty and stents page.

An angiogram gives a definitive answer about the state of your heart arteries — information no other test can provide with the same precision — and opens the door to immediate treatment if needed. It is one of the most frequently performed procedures in cardiology and is very safe. Bruising at the wrist or groin is relatively common and settles by itself; serious complications, such as damage to an artery, heart attack, stroke or a reaction to the dye, are rare. We will discuss your individual risks in clinic and provide written information to help you make an informed choice.

A diagnostic angiogram is normally a day-case procedure — most patients go home a few hours afterwards, with a small compression band on the wrist for the first couple of hours. You should not drive on the day of the procedure and will need someone to take you home; most patients are back to normal activities within a day or two.

A diagnostic angiogram is normally a day-case procedure — most patients go home a few hours afterwards, with a small compression band on the wrist for the first couple of hours. You should not drive on the day of the procedure and will need someone to take you home; most patients are back to normal activities within a day or two.

Dr Demir is a Consultant Interventional Cardiologist practising at leading Private London Centres. He trained at leading London hospitals including St Thomas’ and Hammersmith, and completed an advanced fellowship in coronary and structural interventions in Milan, Italy. He performs  coronary procedures regularly, operates radial-first, and uses pressure-wire assessment routinely to ensure treatment decisions are precise and evidence-based.

Contact Ms Amelia Garner (PA) on 020 3198 9826 or drozandemir.sec@outlook.com to arrange a consultation.