The video below is an excellent review of catheter based coronary angiography.
With coronary angiography we seek to answer the question “Does the patient have flow limiting coronary artery stenosis or stenoses that could benefit from percutaneous coronary intervention or coronary artery bypass graft surgery.
The potential benefits of a coronary intervention are:
- Reduction in all cause mortality or myocardial infarction in excess of what can be achieved with medical therapy.
- Reduction in anginal symptoms in excess of what can be achieved with medical therapy.
The only chance for the patient to benefit from a coronary intervention is if the angiogram reveals flow limiting stenoses.
Flow limiting stenoses are those coronary artery narrowings that prevent the increased coronary artery flow that normally occurs with exercise.
However, it may be impossible to determine with visual interpretation whether or not a coronary artery stenosis visualized on coronary angiography is flow limiting.
The video below well reviews all the pitfalls of only visually interpreting the coronary angiogram. And the video addresses technology that can prevent those pitfalls.
Here is a link to the video Limitations of the Coronary Angiogram: More than Meets the Eye – Cardiology Grand Rounds , Jan 16, 2016 by William Fearon, MD, of Stanford University Medical Center.
Additional Resources:
Five-Year Outcomes with PCI Guided by Fractional Flow Reserve [PubMed Abstract] [Full Text HTML] [Full Text PDF]. N Engl J Med. 2018 Jul 19;379(3):250-259.
The above article has been cited by 15 PubMed Central Articles.
