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MainInterventional cardiology

Interventional cardiology

What is it?
Angiography - a method that allows to assess the internal lumen of the vessels - presence in it of constrictions, extensions, or complete interruption of blood flow through the vessel. The method is based on possibility to see in the X-ray radiation of the angiographic apparatus the special solution introduced into the vessel (X-ray contrast material).
In our Center, the main strands of work of the X-ray operating room are examinations of the heart arteries - coronary angiography, which has rightfully become the gold standard in the study of the heart arteries all over the world. Also in the X-ray operating room of our Center, other studies of blood vessels are also performed: legs, arms, neck, brain, abdominal organs, kidneys, aorta. But unlike coronary angiography, these studies may be inferior in their informativeness in comparison with a CT scan, or an ultrasound machine.
Why is it necessary?
The main task of angiography is to study the state of the vessels, whether it be the vessels of the heart, legs, or head. There is a lot of vascular diseases, not for each of them the angiography will be useful, but there are also those where this study can not be dispensed with. For example, the angiography has proven itself in both diagnosis and treatment of atherosclerotic lesions of the heart arteries. The  atherosclerosis is the main cause of such serious diseases as myocardial infarction and brain stroke. In the vessels, atherosclerotic plaques are formed, which gradually increasing in size can significantly constrict the lumen of the artery, if not to block it. As a result, the nutrition of the organ that they supply with blood is disturbed, and there comes the death of the cells of this organ (eg myocardial infarction).
Thanks to angiography, we can find, assess and, if possible, restore blood flow in such a vessel by installing a stent in it - a special metal prosthesis.

Before: Constriction, embarrassing the blood flow
    After stent deployment: The blood flow is restored

All this is done through a small puncture in the groin area, or the forearm under local anesthesia and in full consciousness of the patient. Of course, the method has its limitations and not all variants of vascular lesions can be corrected without resorting to an "open" operation. But to learn these details, it is possible only after the diagnostic study - angiography.
There are many indications for carrying out vascular studies. In our Center, coronary angiography is mainly performed - the study of the heart arteries, as a method of diagnosing of the ischemic heart disease (IHD). Also, an indication may be chronic arterial insufficiency of the lower extremities, or chronic cerebrovascular disease. The need for this procedure should be determined by a physician. 
There are no absolute contraindications to angiography. This, however, does not mean that angiography needs to be performed by everyone. The reasons for abstaining from the procedure can be clarified only when consulting a specialist taking into account not only the underlying disease, but also the concomitant pathology.
How to do it?
On the example of coronary angiography
The coronary angiography is performed under local anesthesia (only the puncture locus is anesthetized), and is similar in morbidity to intravenous injection. Throughout this manipulation, the patient is conscious and can communicate with the doctor.
The first stage of coronary angiography is a puncture of the skin and introduction through the arm artery (radial artery) or the leg artery (femoral artery in the inguinal region) of a 2-3 mm thick catheter. The catheter is conducted to the heart. Given that there are no pain receptors inside the vessels, the patient does not feel the progress of the catheter. Then, an X-ray contrast medium is introduced through the catheter, and its movement along the arteries in the X-ray radiation is observed. After that, the catheter is removed, and the artery at the puncture locus is temporarily pressed down until the defect in this place is closed by itself.
The entire procedure is recorded on a CD or DVD disc and is considered as indicant one during 6 months.
The duration of the procedure, if only a coronary angiography is performed, is usually about 20-40 minutes. After the coronary angiography, the patient is transferred to the patient’s room to be   supervised by the on-duty staff, or, if necessary, to the intensive care room. If the access has been made through the femoral artery, the patient will not be allowed to walk for 12-24 hours. A planned coronary angiography, without complications, requires hospitalization for up to 3 days.
How safe is this procedure? 
It must be understood that there are no absolutely safe procedures with violation of the skin. When carrying out coronary angiography, there are certainly complications, as they can be even with ear piercing. Complications of angiography are quite rare, and the most frequent of these are the following:
•    hematoma (bruise) at the puncture locus;
•    bleeding from the puncture locus;
•    allergic reactions to medications used;
•    contrast-induced nephropathy.
All these complications can be easily treated.
Irradiation with X-ray certainly does not add health, but, firstly, a dose received by the patient is small enough, and, secondly, it is an occasion to perform such a procedure only if there is evidence for this.
Is there an alternative?
For the arteries of the heart, generally speaking, there are no alternatives. Although the examination of the coronary arteries with the help of a computer tomograph is growing in strength, but it is rather a method of diagnosis in the future, not in the present. There are also many methods of confirming myocardial ischemia, but all these methods will only bring a person closer to the need for coronary angiography.
The vessels of other organs can be successfully studied using ultrasound and CT.
Our technical capabilities
•    2 modern angiographic complexes
•    OCT - optical coherent tomograph
•    FFR - determination of fractional blood flow reserve
•    IVUS - intravascular ultrasound scanner
•    Rotablator - a device for removing calcium from the coronary arteries
With the help of these devices and diagnostic methods, it is possible to obtain both the most reliable diagnostic information and determine a tactics of further treatment, and to perform directly a therapeutic endovascular procedure. 

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