What to expect during an angiogram

If we’ve recommended that you have a heart catheterization (also called a coronary angiogram), it’s helpful to understand what to expect during the procedure.

When you arrive at the cardiac catheterization lab, you’ll receive sedation to help you stay relaxed and comfortable throughout the procedure. In about 90% of cases, we perform the procedure through the artery in your wrist. We also prepare your leg as a backup in case we are unable to use the wrist.aAfter numbing the wrist, we insert a small catheter (a thin, hollow tube) and guide it to the heart. We then inject contrast dye containing iodine into the coronary arteries, so we can clearly see blood flow. Healthy coronary arteries appear smooth while arteries with cholesterol buildup may appear narrowed, almost like an hourglass.

If we identify a significant blockage (especially one that appears active or matches the findings from your stress test), we will usually recommend performing an angioplasty and placing a stent.

To do this, we guide a small wire through the blocked artery, followed by a tiny balloon. A second balloon with a wire mesh stent mounted on it is then positioned within the blockage. The balloon is inflated, expanding the stent and pressing the plaque against the artery wall. After the balloon and wire are removed, the wire mesh stent remains in place to help keep the artery open.

The entire procedure typically takes about an hour even if a stent is placed, and you remain sedated throughout.

The risk of a serious complication (including death, stroke, loss of a limb or loss of kidney function) is approximately 1 in 1,000. There is also about a 1 in 100 chance of a complication at the access site in the wrist or leg with the most common being a large bruise (known as a hematoma).

There is also approximately a 1 in 100 chance that emergency heart surgery may be needed. This can occur if we attempt to open an artery and it does not respond as expected, such as when the artery will not open, the stent cannot be fully expanded or the artery closes unexpectedly during the procedure.

Despite these potential risks, most patients go home the same day even if they receive a stent. After the procedure, the catheters are removed from the wrist or leg. You’ll be monitored for a few hours. If everything looks good, you’ll be discharged home the same day.

This is the general process of a heart catheterization, also known as a coronary angiogram.