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Coronary Angiography & Angioplasty
An Introduction

Angiography was first started in 1959, by Dr. Mason Sones, in the US, when he inadvertently canulated the right coronary artery of a 7 year old child. He performed this procedure through the brachial artery, by the technique of cutting down the artery. Later, Mel Jutkins, a radiologist devised preformed catheters which could be inserted through the femoral artery in the groin and could canulate the coronary arteries very simply.

In 1979, Andreas Gruentzig performed the first angioplasty in a 38 year old insurance salesman, who is still alive to bear testimony to the wonders of modern medicine. With this was born a procedure that has changed the way in which coronary artery disease is approached today.

Somewhere in the early Ď90s, a doctor from Canada started performing coronary angiography through the transradial approach. However, it was only in 1993 that Ferdinand Kemineji did the first angioplasty through the transradial approach. And this further revolutionised the way in which angioplasty was performed. Stents came in the late 1980s and it was Ulrich Sigwart who performed the first stenting procedure in a human and this reduced many of the complications associated with Angioplasty. Drug eluting stents, to reduce the burden of recurrence (restenosis) came in the early 21st century and this has further increased the utility of angioplasty by allowing a greater number of patients to be treated, including those with diabetes, small vessels, long lesions, calcification and bifurcation lesions.

It was in 1985 that Bill OíNeal and Cindy Grinds from Michigan, USA provided wide based evidence that angioplasty performed during a heart attack was much superior to administering thrombolytic therapy (clot busters). Thus was born the procedure of primary angioplasty in myocardial infarction (PAMI).

The Procedure

Coronary Angiography in most institutes is still performed through the groin, where after puncturing the femoral artery, a fine and floppy wire is passed into the aorta through the femoral artery, under vision. The needle is then removed and a dilator and sheath are inserted over this wire, this passage now becomes the passage through which all intervention will occur. After the removal of the wire and dilator, the catheter is advanced over another wire, till it reaches the ascending Aorta. It is at this point that this wire is also removed and the catheter is advanced to enter the coronary ostium. The contrast dye is then injected and a recording on film or CD is made so that any of the blocks can be visualized in the coronary artery in various views.

At Holy Family Hospitalís Heart Institute, most angiography procedures have been performed via the transradial route, since 2003. This is done by inserting the sheath and subsequently the catheter though the radial artery, in the wrist. This catheter is then advanced through the radial, over a wire, till it reaches the ascending aorta, then this wire is removed and the catheter is advanced to canulate the coronary ostium. Through the transradial route, the same catheter can be used to canulate both the right and the left ventricle, it therefore reduces the time required for the procedure. This procedure also has reduced bleeding complications, which are more frequent through the groin route. It also allows greater patient comfort, ie allowing the patient to sit or stand immediately after the procedure, reduces incidences of back ache and problems discharging urine. This procedure also permits for early discharge.

Who Needs It

Typically, angioplasty is required when a blood vessel becomes narrow, constricted or obstructed; this may happen due to a variety of reasons ranging from arteriosclerosis, hypertension, diabetes to excessive smoking.

With a fatality rate of less than 1%, angioplasties are much safer than bypass surgery and therefore available to a wider spectrum of patients, including those with higher cardiac risk factors, such as:
  • patients older than 75 years
  • patients who suffer from diabetes or kidney disease
  • patients with extensive heart disease or blood clots in the heart arteries
  • people with poor pumping function in their hearts
  • women
Angioplasty (with stenting) has shown considerable positive effects in:
  • Cardiovascular disease
  • Coronary artery disease
  • Cardiac ischemia
  • Myocardial infarction
  • Tearing of arteries, resulting in total blockage and possible myocardial infarction; this can usually be repaired with a stent
  • Dislodging of a clot, which may cause a stroke in some circumstances
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