Coronary catheterization
Coronary catheterization | |
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Angiocardiography | |
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ICD-9-CM | 88.50-88.58 |
MeSH | D000790 |
A coronary catheterization is a
Coronary catheterization is one of the several
History
The technique of angiography itself was first developed in 1927 by the Portuguese physician
Heart catheterization was first performed in 1929 when the German physician Werner Forssmann inserted a plastic tube in his cubital vein and guided it to the right chamber of the heart. He took an x-ray to prove his success and published it on November 5, 1929, with the title "Über die Sondierung des rechten Herzens" (About probing of the right heart).[citation needed]
In the early 1940s,
In 1960 F. Mason Sones, a pediatric cardiologist at the Cleveland Clinic, accidentally injected radiocontrast in a coronary artery instead of the left ventricle. Although the patient had a reversible cardiac arrest, Sones and Shirey developed the procedure further, and are credited with the discovery (Connolly 2002); they published a series of 1,000 patents in 1966 (Proudfit et al.).
Since the late 1970s, building on the pioneering work of
In the early 1960s, cardiac catheterization frequently took several hours and involved significant complications for as many as 2–3% of patients. With multiple incremental improvements over time, simple coronary catheterization examinations are now commonly done more rapidly and with significantly improved outcomes.[citation needed]
Indications
Indications for cardiac catheterization include the following:
- Heart Attack (includes ST elevation MI, Non-ST Elevation MI, Unstable Angina)
- Abnormal Stress Test
- New-onset unexplained heart failure
- Survival of sudden cardiac death or dangerous cardiac arrhythmia
- Persistent chest pain despite optimal medical therapy
- Workup of suspected Prinzmetal angina (coronary vasospasm)[2]
Patient participation
The
Death,
Equipment
Coronary catheterization is performed in a catheterization lab, usually located within a hospital. With current designs, the patient must lie relatively flat on a narrow, minimally padded, radiolucent (transparent to X-ray) table. The X-ray source and imaging camera equipment are on opposite sides of the patient's chest and freely move, under motorized control, around the patient's chest so images can be taken quickly from multiple angles. More advanced equipment, termed a bi-plane cath lab, uses two sets of X-ray source and imaging cameras, each free to move independently, which allows two sets of images to be taken with each injection of radiocontrast agent. The equipment and installation setup to perform such testing typically represents a capital expenditure of US$2–5 million (2004), sometimes more, partially repeated every few years.[citation needed]
Diagnostic procedures
During coronary catheterization (often referred to as a cath by physicians),
The catheter is itself designed to be
If
For guidance regarding catheter positions during the examination, the physician mostly relies on detailed knowledge of internal anatomy, guide wire and catheter behavior and intermittently, briefly uses
Though not the focus of the test, calcification within the artery walls, located in the outer edges of atheroma within the artery walls, is sometimes recognizable on fluoroscopy (without contrast injection) as radiodense halo rings partially encircling, and separated from the blood filled lumen by the interceding radiolucent atheroma tissue and endothelial lining. Calcification, even though usually present, is usually only visible when quite advanced and calcified sections of the artery wall happen to be viewed on end tangentially through multiple rings of calcification, so as to create enough radiodensity to be visible on fluoroscopy.
For congenital malformations
Angiocardiography can be used to detect and diagnose congenital defects in the heart and adjacent vessels.[4] In this context, the use of angiocardiography has declined with the introduction of echocardiography. However, angiocardiography is still in use for selected cases as it provides a higher level of anatomical detail than echocardiography.[5][6]
Therapeutic procedures
By changing the diagnostic catheter to a guiding catheter, physicians can also pass a variety of instruments through the catheter and into the artery to a lesion site. The most commonly used are 0.014-inch-diameter (0.36 mm) guide wires and the balloon dilation catheters.[citation needed]
By injecting radiocontrast agent through a tiny passage extending down the
Typical normal
Additionally, several other devices can be advanced into the artery via a guiding catheter. These include
Stents, which are specially manufactured expandable stainless steel mesh tubes, mounted on a balloon catheter, are the most commonly used device beyond the balloon catheter. When the stent/balloon device is positioned within the stenosis, the balloon is inflated which, in turn, expands the stent and the artery. The balloon is removed and the stent remains in place, supporting the inner artery walls in the more open, dilated position. Current stents generally cost around $1,000 to 3,000 each (US 2004 dollars), the drug-coated ones being the more expensive.
Advances in catheter-based physical treatments
Interventional procedures have been plagued by
Alternative approaches
Radiation dosage
Angiography
Imaging in coronary angiograms is performed via fluoroscopy using X-rays, which pose a potential for increasing the patient's risk of radiation-induced cancer. The risk increases with the exposure time, consisting of 1) time guiding the probe into and out of the heart and 2) time illuminating the contrast agent to perform the angiogram. Absorbed radiation is also a function of body mass index, with obese patients having twice the dose of normal-weight patients; exposure to the operator was also doubled.[8] Coronary angiograms can be done either transradial (through the wrist) or transfemoral (through the groin).[9] The transradial route results in somewhat greater patient and operator exposure. Overall, patient exposure can range from 2 millisieverts (equivalent of about 20 chest x-ray plates) to 20 millisieverts.[10] For a given patient, exposure can vary within an institution and between institutions by up to 121%.[11]
Radiation exposure to the operator can be reduced by the use of protective equipment. Exposure to the patient can be reduced by minimizing fluoroscopy time.
See also
References
Notes
- ISBN 0-7817-4868-2.
- ISBN 978-1608319053.
- ISBN 0-07-142264-1.
- ISBN 0-7817-5098-9.
- ISBN 0-470-09316-1.
- ISBN 3-540-66703-2.
- ^ "Angiogram vs. CT Catscan Angiogram". Archived from the original on May 11, 2013. Retrieved July 19, 2013.
- ^ Ashish Shah et al., Radiation Dose During Coronary Angiogram: Relation to Body Mass Index, Heart, Lung and Circulation (2015), vol. 24, pp. 21–25
- S2CID 58611326.
- ^ 2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging: Best Practices for Safety and Effectiveness, Journal of the American College of Cardiology May 2018
- ^ [1] Clara Carpeggiani et al., Variability of radiation doses of cardiac diagnostic imaging tests: the RADIO-EVINCI study, BMC Cardiovascular Disorders, 16 February 2017
General
- Connolly JE. The development of coronary artery surgery: personal recollections. Tex Heart Inst J 2002;29:10-4. PMID 11995842.
- Proudfit WL, Shirey EK, Sones FM Jr. Selective cine coronary arteriography. Correlation with clinical findings in 1,000 patients. Circulation 1966;33:901-10. PMID 5942973.
- Sones FM, Shirey EK. Cine coronary arteriography. Mod Concepts Cardiovasc Dis 1962;31:735-8. PMID 13915182.
- [2] Coronary CT angiography by Eugene Lin
- [3] Abbott Dissolving Stent May Be 'Next Revolution' by Michelle Fay Cortez
- Selzer, Arthur (1992). Understanding heart disease. University of California Press. p. 43. ISBN 0-520-06560-3.