Cardiovascular Disease Prevention: Coronary Angiography and Computed Tomography

Cardiovascular diseases are the leading cause of death in Western countries. The underlying cause is a pathological process affecting the arterial system, potentially leading to progressive narrowing of the arteries until complete blockage. Atherosclerosis, a chronic disease affecting arterial walls in various areas, is the primary cardiovascular disease. When affecting the coronary arteries, it can cause angina pectoris and myocardial infarction. If it affects the cerebral vascular system, particularly the carotid arteries, it can lead to stroke, while affecting the lower limbs can cause claudication.

Cornerstones of prevention, crucial for controlling the disease, include:

• A healthy lifestyle;
• A proper diet;
• Adequate physical activity;
• Smoking cessation;

Exams for Diagnosing Cardiovascular Diseases

Because the pathological process leading to arterial narrowing is progressive and often asymptomatic for a long time, preventive strategies are key to identifying at-risk individuals. Comprehensive cardiovascular assessment requires thorough examinations, such as color Doppler echocardiography of various vascular areas (particularly the carotids, lower limbs, and abdominal aorta). Furthermore, in some cases, CT angiography: an examination capable of highlighting anomalies that may promote the onset of pathologies affecting the vascular system.

Regarding coronary artery health, if basic examinations such as electrocardiogram (ECG) and stress tests are insufficient to clarify the patient's clinical picture, coronary computed tomography is necessary. This minimally invasive examination is a valid alternative in many cases to coronary angiography (which remains the gold standard for studying coronary circulation), which can be used in certain situations.

Angio-CT

What is Angio-CT?

Angio-CT is a radiological examination combining the capabilities of computed tomography (CT) and angiography (a more invasive and complex diagnostic examination) to study blood circulation in the body's vessels and arteries, organ supply, and vascular anomalies and pathologies:

• Stenosis;
• Aneurysms;
• Tears in major arteries and possible thrombi in the vein;

It is performed with a contrast agent, i.e., injecting an iodine-based medication a few minutes before the examination, resulting in sharper, more precise images of tissues and vessels.

What is Angio-CT used for?

Angio-CT can be used to diagnose:

• Intracranial or cerebral aneurysms;
• Thoracic aortic aneurysm;
• Abdominal aortic aneurysm;
• Malformations affecting vessels, such as excessive openings (patency) or partial closures (stenosis) of the carotid arteries;
• Traumatic injuries to blood vessels;
• Diseases affecting the heart (such as coronary artery disease or aortic dissection, which can affect both the abdominal and thoracic regions);
• Anomalies in blood circulation in the body's organs;

How is the procedure performed?

The examination only involves placing a needle in an arm vein (unlike angiography, which requires inserting a catheter into an artery). After reviewing medical history to rule out pregnancy or allergies, the physician administers the contrast agent. This examination requires minimal preparation: the patient must be completely fasting for at least 6 hours before undergoing Angio-CT. The test takes about 20 minutes in total, after which you can resume normal activities.

Contraindications

Angio-CT is contraindicated for individuals with past allergic reactions to the contrast agent or severe kidney failure (the radiopharmaceutical must be excreted in urine within hours of the examination). Pregnant women are also not allowed to take the test, as the fetus could be harmed. The test is also not recommended for patients with diabetes and severe obesity.

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Coronary CT

What is Coronary CT?

Coronary computed tomography, or coronary CT scan, is a radiographic procedure to examine the health and function of the coronary arteries, the arteries that carry blood and oxygen to the heart. It's usually indicated when electrocardiogram and stress tests fail to provide a precise diagnosis. It's also useful for monitoring patients post-revascularization surgery. It can be performed with or without contrast agent and is minimally invasive.

What is Coronary CT used for?

Coronary CT is used to diagnose:

• Anatomical alterations of the coronary arteries and the first part of the aorta;
• Diseases affecting the coronary arteries, or coronary artery disease, caused by obstruction of blood flow to the heart, which can be total or partial (a condition favored by atherosclerosis);
• Coronary vasculitis, i.e., inflammation of the heart arteries;
• Emboli, i.e., the presence of clots or air bubbles that may affect the pulmonary arteries;

How is the examination performed?

Before the test, the physician reviews the patient's medical history to rule out any allergies or pregnancy if the patient is female. Then, intravenous contrast agent is administered, and imaging begins. The examination lasts about 30 minutes. After the examination, it is necessary to wait another half hour before going home. To help excrete the contrast agent, drinking plenty of fluids throughout the day is advised.

When performed with a contrast agent, coronary CT requires the patient to fast for at least 6 hours beforehand. Blood samples are also taken in the days preceding the test to measure creatinine and urea and check kidney function.

Contraindications

Coronary CT, like CT angiography, is contraindicated for people with past allergic reactions to the contrast agent, those with severe kidney failure, and pregnant women.

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