Interventional cardiology: coronary angiography, angioplasty and stents — in which situations are they necessary?

Coronary angiography and angioplasty: two different procedures

Coronary angiography is an invasive examination that shows the coronary arteries using a catheter and a contrast agent. Angioplasty (PCI) is a treatment: a balloon and often a stent are used to reopen a significantly narrowed or blocked artery. A coronary angiogram therefore does not automatically lead to a stent being placed.

In a heart attack, time matters

In some acute coronary syndromes, particularly heart attacks with ST-segment elevation, rapid revascularisation may be urgent. The 2023 ESC guidelines cover the whole pathway: diagnosis, risk stratification, antithrombotic treatments, invasive assessment and revascularisation.

Suggestive chest pain, the electrocardiogram and troponin levels guide the assessment; the care pathway must then be organised as an emergency, not as a planned test.

How is coronary angiography performed?

Access is most often through an artery in the wrist (radial) or sometimes in the groin (femoral). Under local anaesthetic, a catheter is advanced up to the coronary arteries. The contrast agent reveals the narrowings. If angioplasty is indicated and feasible, it can be performed during the same procedure.

Physiological measurements or imaging inside the artery can sometimes help decide whether a lesion should be treated.

What is a stent for?

A stent is a small tube-shaped implant that keeps the artery open after it has been widened. Modern stents are generally drug-eluting, meaning that they release a medicine that reduces the risk of re-narrowing (restenosis). After placement, antiplatelet treatment is crucial; it must not be stopped without the cardiologist’s advice, especially in the first weeks and months.

Stent or bypass?

For complex or multiple lesions, bypass surgery may be preferable. The decision may be taken by a specialised medical and surgical team (“Heart Team”) combining interventional cardiology and cardiac surgery, taking into account the coronary anatomy, diabetes, heart function and the patient’s priorities.

What are the risks?

Bruising at the puncture site, bleeding, a reaction to the contrast agent, kidney damage, a rhythm disorder or a complication involving the artery are possible. Serious complications are rare but depend greatly on the context: an unstable heart attack does not carry the same risk as a planned procedure.

After the operation

Care does not end with the stent. Controlling blood pressure, cholesterol and diabetes, stopping smoking, appropriate physical activity, cardiac rehabilitation and the prescribed treatments reduce the risk of another event.

The stent treats one lesion, but atherosclerosis is a diffuse disease that requires long-term secondary prevention.

Coming from abroad for coronary angiography or angioplasty

For a patient living outside Morocco, two situations must be distinguished. Acute chest pain suggesting a heart attack requires emergency care on site: travel must not delay treatment. A planned coronary angiography, on the other hand, can be prepared from the file: electrocardiograms, echocardiogram, exercise test or stress imaging, blood tests and current treatments.

After a stent is placed, antiplatelet treatment must continue without interruption after the return. Before discharge, check that the prescribed medicines are available in the home country, or plan a sufficient supply, and that the doctor taking over follow-up knows how long they are to be taken. The time before the return flight is set by the cardiologist, according to the context of the procedure and the recovery.

Frequently asked questions