The similarities, differences, advantages and disadvantages of two methods for diagnosing intracoronary artery patency – “coronary angiography” (CAG) and “coronary artery imaging” (CTA).
Coronary angiography (CAG): Coronary angiography is a common and effective method for diagnosing atherosclerotic heart disease (coronary artery disease). Selective coronary angiography involves using an angiography machine to percutaneously puncture into the femoral artery of the lower extremity (or the flexural artery of the upper extremity) through a specially shaped cardiac catheter, retrograde along the artery to the root of the aorta, and then explore the left or right coronary artery opening for insertion and inject contrast to visualize the coronary arteries. In this way, the entire lumen of the trunk of the left or right coronary artery and its branches can be clearly shown, and it is possible to understand the presence of stenotic lesions, make a clear diagnosis of the site, extent, severity and condition of the vessel wall, and decide the treatment plan (interventional, surgical or medical treatment), and implant stents at the same time, which can also be used to judge the efficacy of treatment. This is a safe and reliable invasive diagnostic technique, which is now widely used in clinical practice and is considered to be the “gold standard” for diagnosing coronary artery disease.
Coronary artery imaging (CTA): A non-invasive technique that uses CT to examine the coronary arteries via superficial intravenous injection of enhancer to understand the presence of stenotic lesions in the coronary vessels, the location, extent, severity and wall condition of the lesions, etc. The diagnostic accuracy of CTA is second only to CAG. CTA is ideal for the screening of coronary artery disease, the review of confirmed coronary artery disease, the review of coronary artery after stent placement and bypass surgery, etc.; 2) the examination process is convenient and fast, and the scanning time with 64-layer spiral CT is only about 9-11 seconds; 3) the image of coronary artery is clear and the diagnosis is accurate. It can accurately show the presence or absence of stenosis, the cause of stenosis, determine the nature of the plaque in the intima of the artery, and determine whether it is stable or not; 4) the examination has more information, and the coronary calcification score can be measured at the same time, and the myocardium and heart chambers can be observed at the same time as observing the coronary arteries; 5) the examination cost is lower than that of CAG. The disadvantages are that not all people can be tested. Note: 1) The heart rate of the subject should be controlled below 70 beats per minute when CT coronary artery examination is performed. If the heart rate is too fast, the patient should take oral medication to control the heart rate before the examination under the guidance of the doctor. 2) Stenting cannot be done at the same time as the examination.
The common points of the above two tests are
1) Fasting or a small amount of water is required before the test. 2) Patients with iodine allergy and severe liver and kidney disease are contraindicated.
Of course, in recent years, intracoronary ultrasound imaging (IVUS) and optical interferometric tomography (OCT) have been gradually applied in clinical practice, and it is found that some of the coronary angiograms (or imaging) show the presence of intimal thickening or plaque in normal vessel segments.
I. Similarities and differences
CAG (angiography)
CTA (imaging)
Similarities
1, contrast agent: the same iodine contrast agent.
2. Scanner: the same CT is used.
3. examination effect: both can reflect the degree of atherosclerosis, plaque formation and stenosis.
Differences
1. Injection of enhancer from artery.
2. Stents can be implanted.
1. Injecting enhancer from vein.
2. No stent can be implanted.
II. Advantages and disadvantages
CAG (Contrast)
CTA (imaging)
Advantages
1. Clear image, easy to distinguish pathology from normal.
2. Possibility of simultaneous stent implantation.
3. Mechanical lumen evacuation can be performed at the same time.
1. Less technical difficulty in operation.
2. Less risky operation.
3. The cost is relatively low.
4. The examination can be performed on an outpatient basis.
Disadvantages
1, requires skilled professionals to operate.
2, there is a certain risk.
3. The cost of examination is relatively high.
4. Generally need to be hospitalized for examination.
1. Image clarity is not as good as coronary angiography.
2. Cannot be performed with stent implantation.
3. Cannot be used to perform therapeutic de-stenting operation in the lumen of blood vessels.
In summary, “coronary artery imaging” (CTA) can be used to check the condition of coronary arteries in general or for medical examination or for those who do not intend to install stents; while “coronary artery imaging” can be used for emergency rescue, or for those who intend to install stents, or for those who still feel that the results of “coronary artery imaging” are unsatisfactory. If the results are not satisfactory, coronary angiography (CAG) can be used.
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