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Coronary angiography in the angioplasty era: projections with a meaning
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  1. Carlo Di Mario,
  2. Nilesh Sutaria
  1. Royal Brompton Hospital, London, UK
  1. Correspondence to:
    Professor Carlo Di Mario
    Royal Brompton & Harefield NHS Trust, Sydney Street, London SW3 6NP, UK; c.dimariorbh.nthames.nhs.uk

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Many textbooks, atlases, and handbooks discuss the techniques for obtaining optimal views of all segments of the coronary arterial system. Most of these chapters, however, were written in an era when coronary surgery was the prevailing revascularisation treatment and little attention was paid to details of the lesion site and its relation with branches. Operators and surgeons were satisfied that the coronary angiogram provided sufficient information to judge whether lesions were “significant”—that is, deserving revascularisation, or “non-significant”, to be left alone and allowed visualisation of the likely site of coronary anastomosis of the bypass graft and its “run-off”. Percutaneous transluminal coronary angioplasty (PTCA) has now become the dominant method for coronary revascularisation, with a ratio of PTCA: coronary artery bypass graft surgery (CABG) of between 4–8:1 in most European countries and 2.1:1 in the UK in 2003.1 With the exception of the UK, where we are still seeing new catheter laboratories being opened for purely diagnostic purposes, in the worldwide setting coronary angioplasty is carried out immediately after diagnostic angiography. Besides cost and organisational benefits, this approach offers advantages in terms of morbidity and mortality in unstable patients when rapid treatment reduces the incidence of ischaemic events.2 Under this pressure, diagnostic angiography has evolved from a standard series of 8–9 views for the left coronary artery and 2–3 views for the right coronary artery to a more focused imaging modality. Nowadays, a limited number of projections are used to provide an overview of the status of the coronary arterial tree and to identify the ideal projections to be used as working views for coronary angioplasty.

CATHETER SELECTION AND MANIPULATION: WHICH SIZE AND TECHNIQUE

With improvements in catheter technology, 6 French thin walled catheters provide equivalent or better flow rates compared with old 7 and 8 French diagnostic catheters (table 1). Satisfactory coronary opacification can now be …

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    BMJ Publishing Group Ltd and British Cardiovascular Society
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    BMJ Publishing Group Ltd and British Cardiovascular Society