Coronary angiography

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Contrast media display of the coronary vessels. The left coronary artery is shown with the Ramus circumflexus (RCX), which branches down in the initial area, and, in continuation of the main trunk, the Ramus interventricularis anterior (RIVA, syn. LAD). In this illustration, the RIVA emits two so-called diagonal branches of high caliber.
Coronary angiography of partial occlusions of the left coronary artery and the lateral coronary artery ( arteria circumflexa ) (see arrows).
Right coronary artery angiography (RCA) before and after PTCA

The coronary angiography is an angiography of the coronary arteries and thus a special form of x-ray examination , in which the coronary arteries are displayed. It is carried out as part of a cardiac catheter examination . X-rays make an X-ray contrast medium , which is injected into the lumina of the coronary arteries via a cardiac catheter, visible. The recordings were previously documented on film or video material, nowadays on digital storage media .


It is used to diagnose the shape of the coronary vessels (coronary arteries) and to localize stenoses and their type and extent. Coronary stenoses can be expanded with a balloon catheter in the same session ( percutaneous transluminal coronary angioplasty , PTCA) and kept permanently open with the help of a stent . By filling the left heart with contrast agent, disturbances of the contraction process of the heart can be made visible under fluoroscopy (levocardiography).

Diagnostic coronary angiography is indicated in patients


The narrowing of the vessel diameter (degree of stenosis), the morphology of the constriction and the still existing flow are used to describe a constriction.

Degree of stenosis

The extent of a stenosis is given as a percentage of the lumen no longer perfused. Here the longitudinal diameter is given , not the cross-section. A narrowing of the diameter of 75% corresponds to the narrowing of the area of ​​the cross-section to 90%, ie only 10% of the remaining lumen is flowed through. As recommended by the American Heart Association , the following classifications are commonly used.

Degree Stenosis description
diameter Cross-section (area)
0 <25% <44% Contour irregularities, diffuse coronary sclerosis
I. 25-50% 45-75% minor or subcritical stenosis
II 50-75% 75-94% moderate stenosis
III 75 - 90% and> 90% 94 - 99% and> 99% severe or critical stenosis
IV 100% complete closure

Stenosis morphology

According to the recommendation of the ACC / AHA , the following classification is used to describe bottlenecks:

Stenosis type description
A. concentric, short (≤ 1 cm), easily accessible, straight vascular segment, regular contour, little calcified
B. Eccentric, elongated or tubular (1–2 cm), moderately angled (45–90 °), in the area of ​​an ostium , a side branch or a branching of vessels (bifurcation), moderately to severely calcified, thrombus .
B1 = 1 criterion met; B2 = 2 or more criteria met
C. diffuse lesion, elongated (> 2 cm), pronounced tortuous vessel, extremely angled segment (> 90 °), no significant side branch protected, degenerated venous bypass
C1 = 1 criterion met; C2 = 2 or more criteria met

Coronary flow (TIMI classification)

According to the thrombolysis in myocardial infarction classification (TIMI), the coronary flow in the vicinity of a vascular occlusion or a narrowing (stenosis) is described semiquantitatively.

TIMI river description
0 no antegrade flow distal to the occlusion
1 Contrast agent can be displayed distally, but does not fill the entire vascular bed
2 Contrast medium fills the entire vessel distally, but the inflow and outflow are delayed
3 normal flow

Risks and Complications

Main article: Risks and complications of cardiac catheterization

Overall, the risks of coronary angiography can be described as moderate. An increase in risk arises from obesity , impaired kidney function, generalized arteriosclerosis, etc. The most common, but in most cases easily manageable complication is a bleeding into the puncture site of the groin. Furthermore, problems can arise due to the iodine-containing contrast agent used (kidney damage, allergic reaction, derailment of an overactive thyroid , temporary neurological problems). In rare cases, it can also cause cracks of the coronary vessels with life-threatening bleeding into the pericardium ( pericardial tamponade ) and come to infarctions. Also strokes occur in very rare cases.


Web links

Individual evidence

  1. MA Pantaleo, A. Mandrioli et al: Development of coronary artery stenosis in a patient with metastatic renal cell carcinoma treated with sorafenib. (PDF; 287 kB) In: BMC Cancer. 2012, 12: 231 doi: 10.1186 / 1471-2407-12-231 ( Open Access )
  2. a b Krakau, I. / Lapp, H. (Ed.): The heart catheter book - Diagnostic and interventional catheter technology . 2nd Edition. Thieme, Stuttgart, New York 2005, ISBN 3-13-112412-1 , pp. 171-173 .
  3. ^ Harrison (ed.): Internal medicine . 16th edition. 2005.
  4. a b Mewis, Riessen, Spyridopoulos (Ed.): Cardiology compact - Everything for ward and specialist examination . 2nd Edition. Thieme, Stuttgart, New York 2006, ISBN 3-13-130742-0 , pp. 116-117 .