Coronary Angiogram

Coronary Angiogram

Coronary angiography is an investigation in which iodine containing contrast is injected into the coronary artery and cinefluoroscopy recorded using X-ray equipment. Arterial puncture by the percutaneous technique is resorted to in most cases. The usual arteries used are the femoral and radial. Brachial or axillary artery puncture can be used in case the former approaches are not available, but they are usually not preferred. Brachial artery can also be approached through a cut down instead of percutaneous puncture.

Left Coronary Angiogram in RAO Caudal View

LMCA: Left Main Coronary Artery

LAD: Left Anterior Descending Coronary Artery

LCX: Left Circumflex Coronary Artery

OM: Obtuse Marginal branch of LCX

Radial cannulation for coronary angiography is now a days the most preferred approach. In addition to patient convenience and early ambulation with same day discharge, bleeding complications are also lesser with the transradial approach. Downsides are the potential for radial artery spasm, especially when multiple catheter exchanges are needed and small risk of hand ischemia.

But these are rare and hand ischemia is seldom a problem even if there is loss of patency of the radial artery if the collaterals of the superficial and deep palmar arches are good. Barbeau test is a modification of the Allen’s test using pulse oximetry to check the adequacy of the palmar arches prior to radial cannulation.