Coronary Angiography
Imaging of narrowing and blockages in the coronary arteries.
Areas of Expertise
Interventional Cardiology in İzmir: Angioplasty, Stenting, TAVI
Prof. Dr. İstemihan Tengiz has extensive experience in the catheter-based imaging and treatment of coronary arteries. Alongside coronary angiography, angioplasty and stenting, he performs advanced interventional procedures such as chronic total occlusion (CTO) crossing and transcatheter aortic valve implantation (TAVI) at Medicana International İzmir Hospital.
What is coronary angiography and who needs it?
Coronary angiography visualises the arteries supplying the heart under X-ray by injecting contrast through a thin catheter. It is the most definitive method for showing the location, severity and extent of narrowing. The procedure is performed under local anaesthesia; the patient is not put to sleep, remains awake throughout and it usually takes 15-30 minutes.
The decision to perform angiography is based on symptoms together with previous test results. The main indications are ongoing or typical chest pain, a significant finding on exercise testing, myocardial perfusion scintigraphy or coronary CT angiography, suspected heart attack, and investigation of the cause of heart failure. It is not performed as a screening test in people without symptoms or risk indicators.
Preparing for the procedure
Blood count, kidney function and clotting tests are checked beforehand, and fasting for 6-8 hours is usually required. You must tell your physician about all medications you take, particularly blood thinners, diabetes drugs and herbal supplements; some may need to be stopped or adjusted before the procedure.
Any history of allergy to contrast media or iodine, kidney impairment, and the possibility of pregnancy must be reported in advance. In patients with borderline kidney function, intravenous fluids are given before and after the procedure to protect the kidneys.
Angioplasty and stenting (percutaneous coronary intervention)
If a significant narrowing is found, it can be treated with a balloon and stent in the same session or at a separate one. A balloon is advanced to the narrowed segment and inflated to widen the vessel, and a stent — usually drug-eluting — is then placed to prevent it from narrowing again. Contemporary drug-eluting stents markedly reduce the risk of restenosis compared with older bare-metal stents.
Not every narrowing needs a stent. Whether an intermediate-looking lesion genuinely restricts blood flow to the heart muscle is assessed with pressure-wire measurements such as FFR or iFR. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are used to examine plaque structure and to ensure the stent is correctly sized and fully expanded.
Chronic total occlusion (CTO) and advanced procedures
A coronary artery that has been completely blocked for more than three months is called a chronic total occlusion. Crossing these lesions with a catheter requires dedicated wires, microcatheters and advanced techniques, and takes considerably longer than standard angioplasty. The aim is to relieve chest pain that persists despite medication and to restore blood flow to heart muscle that is still viable but underperfused.
Interventional cardiology is not limited to the coronary arteries. Transcatheter aortic valve implantation (TAVI), balloon dilatation of narrowed valves, carotid stenting and endovascular repair of abdominal aortic aneurysm (EVAR) are also performed in the same catheter laboratory without open surgery.
After the procedure: recovery and medication
After a radial (wrist) procedure patients can usually stand within a few hours and are discharged the same or the following day. Femoral (groin) access requires several hours of bed rest. Bruising and mild tenderness at the access site are expected; swelling, increasing pain, fever or bleeding should prompt contact with the centre.
Patients who receive a stent must take a second antiplatelet drug alongside acetylsalicylic acid for a defined period to prevent clot formation inside the stent. The duration depends on whether the procedure was performed for an acute heart attack or for stable disease, and on bleeding risk. Stopping these drugs without consulting your physician can cause life-threatening stent thrombosis.
Risks and complications
In experienced centres coronary angiography is a low-risk procedure, with serious complications occurring in under one per cent of cases. The most frequent are bruising and haematoma at the access site. Less commonly there may be an allergic reaction to contrast, transient deterioration in kidney function, vessel injury, arrhythmia, heart attack or stroke.
The level of risk varies with age, kidney function, vascular anatomy and accompanying conditions. For this reason the expected benefit is weighed against the potential risk in every patient, and the decision is shared with them.
Stent, bypass or medication?
In stable coronary artery disease the first step is strong medical therapy and control of risk factors; intervention comes into play when symptoms persist despite medication or when ischaemia is demonstrated over a large territory. In an acute heart attack, by contrast, opening the blocked artery as quickly as possible is life-saving and time must not be lost.
When there is left main involvement, three-vessel disease, extensive lesions with diabetes, or reduced heart function, the options are discussed in a Heart Team meeting where cardiology and cardiac surgery evaluate the case together. The aim is to choose the approach best suited to the coronary anatomy and the patient's overall condition.
Procedures Performed
Angioplasty and Stenting
Opening blocked arteries with balloon and stent (PCI).
TAVI
Transcatheter aortic valve implantation — valve replacement without open surgery.
CTO
Chronic total occlusion — crossing completely blocked arteries.
Balloon Valvuloplasty
Widening narrowed heart valves with a balloon.
EVAR
Endovascular repair of abdominal aortic aneurysm.
Frequently Asked Questions
Is angiography painful?
Apart from the local anaesthetic injection at the access site, pain is not expected. You may feel a brief sensation of warmth when contrast is injected. When the balloon is inflated you may feel a few seconds of chest pressure, which passes. You remain awake throughout and can communicate with the team.
Wrist or groin access?
Radial (wrist) access is preferred whenever possible: bleeding risk is lower, the patient mobilises earlier and comfort is markedly better. Femoral (groin) access is used when the wrist artery is unsuitable, in procedures requiring highly advanced technique, or when larger catheters are needed.
How long must I take medication after a stent?
The duration of dual antiplatelet therapy depends on the reason for the procedure and your bleeding risk; it is generally shorter in stable disease and longer after a heart attack. Acetylsalicylic acid is usually continued indefinitely. Only the physician who performed your procedure can set the duration — do not stop these drugs on your own even before a dental extraction or surgery; consult your physician first.
How long does a stent last?
The stent embeds into the vessel wall and is not removed; it is permanent. The real issue is restenosis inside the stent or new plaque developing elsewhere in the artery. What minimises that risk is taking your medication regularly, reaching your cholesterol and blood pressure targets, stopping smoking and controlling diabetes.
When can I return to work and driving?
After diagnostic angiography most patients resume normal life within 2-3 days. After stenting for stable disease this is usually about a week. In patients who have had a heart attack, return depends on the extent of heart muscle damage and is planned individually. Wait for your physician's approval before heavy lifting or strenuous activity.
Can medication be used instead of angiography?
In stable coronary artery disease, yes — in many patients strong medical therapy and risk-factor control relieve symptoms and intervention may not be needed. In an acute heart attack, or when symptoms persist despite medication and limit daily life, interventional treatment takes priority. The decision is made by weighing all test results together with your preferences.
Content reviewed by Prof. Dr. İstemihan Tengiz. Last reviewed:
The information on this page is for general information only and is not a substitute for medical advice. Please consult your physician about your symptoms.