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Coronary angiography and

PCI

Samo Granda, Franjo Naji

Department of Cardiology

Clinical department of internal medicine

University clinical centre Maribor

Coronary arteries

Coronary arteries

Atherosclerosis

Myocardial infarction

Coronary angiography (CA)

• invasive diagnostic method for

visualization of coronary arteries

Percutaneous coronary intervention (PCI)

• any therapeutic coronary procedure

usually following CA

• PTCA (percutaneous transluminal

coronary <baloon> angioplasty), stent

implantation, thrombus aspiration...

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Indications for CA:

• suspected coronary disease (angina

pectoris)

• acute coronary syndrome (STEMI, NSTEMI,

UA)

• cardiomyopathies (exclusion of ischaemic

etiology)

• sudden cardiac death (VF...)

• before planned surgical procedure (heart

valves...)

• before heart transplantation

Coronary catheterisation laboratory:

• flouroscopic imaging system (C-arm, x-ray tube,

flouroscopic monitors, physiologic monitors, contrast

injector...)

• patient table

• radiation free

monitoring location

• radiation safety

(glasses, thyroid

shield, lead coat)

• rescuscitation

equipment, drugs...

The procedure:

• patient conscious but slightly sedated

• patient in supine position on the table

• sterile preparation (vascular site,

equipment, operators...)

Femoral or radial access site

Radial artery approach Radial artery approach

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Radial artery approach Radial artery approach

Radial artery approach Radial artery approach

Radial artery approach Femoral artery approach

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The procedure:

• the 0,035'' guidewire with J tip in

introduced through the vascular sheath

• the wire is pushed forward under

flouroscopic guidance to the ascending

aorta

J tipped Guidewire

The procedure:

• a diagnostic left coronary catheter is

inserted over the wire

• the catheter is pushed to the ascending

aorta

• the wire is removed

• the catheter is connected to the

hemodynamic monitoring and contrast

delivery device

Diagnostic coronary catheters

The procedure:

• a diagnostic coronary catheter is rotated

and manipulated to engage the coronary

ostium

• the contrast is delivered to ensure the

right placement of the catheter

The procedure:

• x-ray C-arm is rotated to the standard

projections (views)

• a small amount of contrast is delivered in

every projection

• a cine loop is recorded in every

projection

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Coronary x-ray projections (views) Coronary x-ray projections (views)

Left coronary artery LAO45/CR20 Left coronary artery LAO45/CA20

Left coronary artery RAO10/CA20 Left coronary artery RAO10/CR30

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The procedure:

• a diagnostic left coronary catheter is

removed from the coronary ostium

• a guidewire is introduced and catheter

removed

• a diagnostic right coronary catheter is

guided to the ascending aorta

• a guidewire is removed

The procedure:

• a diagnostic right coronary catheter is

rotated and manipulated to engage the

right coronary ostium

• the contrast is delivered to ensure the

right placement of the catheter

• cine loops are recorded in standard

views

Right coronary artery LAO40 Right coronary artery RAO40

The procedure:

• a diagnostic right coronary catheter is

removed from the coronary ostium

• a guidewire is introduced and catheter

removed

A real case:

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A real case:

A real case:

The procedure:

• after the coronary stenosis is located a

guiding catheter is introduced over the

wire and inserted into coronary ostium

• the coronary wire 0,018'' is guided

through the catheter

• once in the coronary artery, the wire is

gently pushed, rotated and manipulated

to guide it through the area of stenosis

Coronary wires

Coronary wires Coronary wire accross the stenosis

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Coronary wire accross the stenosis The procedure:

• the baloon catheter is inserted over the

coronary wire and pushed to the place of

the stenosis

• once the baloon catheter is in the right

place it is inflated for about 10 seconds

and then deflated - PTCA

• baloon catheter is removed into the

guiding catheter and the angiographic

result is recorded

Baloon catheters PTCA

PTCA PTCA

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PTCA PTCA

The procedure:

• the baloon catheter is removed

• the coronary stent is inserted over the

coronary wire and pushed to the place of the

stenosis

• once the stent is in the right place it's baloon is

inflated for about 10-20 seconds and then

deflated

• the stent catheter is removed into the guiding

catheter and the angiographic result is

recorded

Coronary stenting

Coronary stenting Coronary stenting

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Coronary stenting – final result Coronary stenting – final result

Other coronary procedures:

• complex stenting of multivessel disease

• bifurcation lesions

• stenting of left main artery

• PCI of chronic total occlusions

• thrombus aspiration

• covered stent implantation

• rotablation (rotational atherectomy)

• IVUS, OCT, FFR

Bifurcation treatment

OCT and IVUS Complications of PCI:

• unsuccessful / incomplete revascularization

• coronary dissection

• coronary rupture

• stent thrombosis

• distal coronary embolization

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Removal of femoral arterial sheath

• haematoma

• A-V fistula

• pseudoaneurysm

• patient must

remain in supine

position for 5-6

hours – very

uncomfortable

Removal of radial arterial sheath

• fewer complications

• patient can walk after the procedure

Thank you!