Selective coronary angiography. Cardiac chamber catheterization. Coronary angioplasty

Selective coronary angiography (SCA), also known as contrast imaging of the coronary arteries

The coronary arteries are blood vessels that supply the heart muscle with oxygen and nutrients. In coronary artery disease, the lumen of the coronary arteries narrows and the blood supply to the heart muscle is impaired. Patients perceive this as discomfort in the chest, known as angina pectoris.
SCA is a hospital-based procedure that allows coronary artery narrowing to be visualized. It is performed, for example, in patients admitted with acute myocardial infarction, or in patients with angina, heart failure, or those planned for cardiac surgery.
During the procedure, a thin flexible plastic tube (catheter) is inserted through the radial or femoral artery into the openings of the coronary arteries. Contrast agent is injected, and the coronary arteries are imaged under X-ray from different angles. The procedure lasts approximately 1 hour.

Catheterization of the heart chambers and major blood vessels

In cases of heart valve disease or heart failure, in addition to examining the coronary arteries, it may sometimes be necessary to measure blood pressure in different heart chambers and major blood vessels such as the aorta or pulmonary arteries. This is done using a catheter inserted into the heart via the radial or femoral artery. The procedure lasts up to 30 minutes.

Coronary angioplasty, also known as percutaneous coronary intervention (PCI)

If significant narrowing of a coronary artery is detected during SCA, widening of the vessel lumen (coronary angioplasty, PCI) may be performed as a continuation of the same procedure. This usually involves dilating the narrowed vessel with a balloon and then placing a thin metal mesh tube (stent) at the site of narrowing.
The stent is inserted into the coronary artery lumen via a catheter through the radial or femoral artery. The stent keeps the vessel open, improves blood supply to the heart muscle, and relieves angina. The stent remains permanently in the vessel and does not move. The procedure lasts 1–3 hours.

Before the procedure

  • Inform your doctor about medication allergies (especially to iodine and local anesthetics such as lidocaine), medications you are taking (especially blood thinners and diabetes medications), previous bleeding episodes, and complications from previous similar procedures.
  • Note that your doctor may ask you to take some of your usual medications differently for a few days before the procedure (e.g. blood thinners, diabetes medications).
  • If you are coming from home, you will be admitted to the hospital early on the day of the procedure or the day before.
  • On the morning of the procedure, take a shower and use the toilet immediately before going for the examination.
  • For 6 hours before the procedure, do not eat, drink liquids (except water), chew gum, or smoke. For 4 hours before the procedure, do not drink water.
  • Before the procedure, your right wrist and groin areas will be shaved (do not do this yourself, as it may increase the risk of wound contamination).
  • An intravenous cannula will be inserted for medication administration.
  • If you use an asthma inhaler or a hearing aid, bring them with you to the procedure. If you have dentures, you may be asked to remove them.
  • If necessary, you will be given a sedative or pain medication before the procedure.
  • The procedure is performed in a specially equipped room resembling an operating theatre. You will be transported there on a bed or in a wheelchair.

During the procedure

  • You will be awake during the procedure and able to speak if necessary.
  • You will lie on your back on the examination table, undressed but covered with sterile drapes. You will be connected to a monitor via wires to monitor vital signs such as heart rhythm.
  • Try to remain as still as possible. If needed (e.g. itching in the nose, chest pain), ask the nurse for assistance, but do not move yourself under the sterile drapes.
  • The doctor selects a suitable arterial puncture site on the inner wrist or in the groin, disinfects it, and administers local anesthesia.
  • After arterial puncture, a catheter is inserted into the blood vessel and advanced to the coronary artery openings. Contrast agent is injected through the catheter into the coronary arteries. You will not feel the catheter moving inside the vessel, but the contrast agent may cause a sensation of warmth, mild nausea, or skin itching.
  • When the contrast agent fills the coronary arteries, they are imaged under X-ray from different angles.
  • If coronary artery narrowing is detected, coronary angioplasty (PCI) may be performed immediately with your consent.
  • During PCI, you may feel brief, uncomfortable chest pain. If pain occurs, pain medication will be administered intravenously if needed.
  • At the end of the procedure, the puncture site is closed to prevent bleeding using a special closure device on the wrist or groin, or a weight or compression device is applied.

After the procedure

  • To prevent stent occlusion, long-term treatment with blood-thinning medications after the procedure is extremely important. Your doctor will determine the exact treatment regimen.
  • After PCI, you will be monitored overnight in the intensive care unit. If only SCA was performed, this is usually not necessary.
  • You may eat and drink immediately after the procedure. To prevent kidney damage caused by the contrast agent, drink plenty of fluids.
  • To prevent bleeding from the puncture site, follow the nurse’s instructions:
    • If the wrist puncture site was closed with a compression device, avoid leaning on that arm or lifting more than 3 kg for 24 hours. You may get out of bed immediately after the procedure.
    • If the groin puncture site was closed with a special closure device, lie flat for 2 hours with the leg straight and a weight on the puncture site. You may then get out of bed.
    • If no closure device was used in the groin and only a weight was applied, lie flat for 6 hours with the leg straight and a weight on the puncture site. You may then carefully turn in bed. You may get out of bed the following morning.
  • Compression devices and weights are removed by the nurse; do not remove them yourself.
  • If the puncture site starts bleeding, inform the nurse immediately.
  • You may be discharged home at the earliest on the day after the procedure.

After discharge from hospital

  • To avoid complications at the puncture site, avoid excessive use of the punctured limb during the first week after the procedure.
  • If the bruise at the puncture site increases in size or swelling or redness develops, contact your family doctor or hospital doctor.
  • Wash yourself in the shower. You may use the bath, swimming pool, or sauna once the scab at the puncture site has fallen off.
  • If the dressing becomes wet or dirty, replace it with a new one. Before applying a new dressing, clean the wound with a skin antiseptic.
  • Take all medications prescribed by your doctor exactly as instructed.

Possible complications of the procedure

  • Complications of the procedure are relatively rare.
  • The most common complications are related to the puncture site (pain, bleeding, bruising), which are usually not dangerous.
  • Occasionally, a vasovagal reaction (fainting) may occur during the procedure.
  • Allergic reactions to the contrast agent occur rarely.
  • Very rarely (in less than 1% of cases), potentially serious complications occur: myocardial infarction, stroke, sudden kidney failure, death.
  • Acute stent thrombosis is a potentially life-threatening complication; to prevent this, you must take blood-thinning medications after the procedure according to your doctor’s instructions.

Compiled by: Ode Laik, Tuuli Teeäär, Märt Elmet, Eve Laane, Urmet Arus
2026