Angiography vs Angioplasty: Differences, Advantages and Disadvantages

What is angiography?

Angiography is a diagnostic procedure that allows visualization of the blood vessels in the body. Its primary use is the identification of blockages and abnormalities caused by conditions like atherosclerosis and stroke. The procedure is done employing an X-ray and a contrast medium. This contrast dye is a fluid which has a specific composition allowing it to absorb the x-rays. By this property, when injected into the blood flow it visualises vessels like arteries which are normally not visible on an ordinary X-ray picture [1, 2].

Depending on the need different types of angiography can be utilized. The most commonly used are cerebral angiography and coronary angiography. Cerebral angiography shows the blood vessels in the head and neck, and is a diagnostic tool for potential stroke or brain bleeding [1, 2]. On the other hand, coronary angiography is used to examine the arteries of the heart. It is used to identify plaque blockages like atherosclerosis [3].

Angiography has evolved over time. It started from a static two-dimensional record of arteries on screen films to real-time two-dimensional display on television monitors. The last development was a three-dimensional reconstruction from computerized tomographic (CT) scans (CT angiogram) [4].

Advantages and disadvantages of angiography?

The biggest advantage of angiography is its ability to provide detailed images of the blood vessel. Thanks to the superior signal-to-noise (S/N) ratio and spatial resolution it is considered the gold standard for the diagnosis of vascular lesions, especially in cardiovascular disease [5]. It is used to evaluate the extent of coronary artery disease (CAD) and is a prerequisite for surgical therapy [6]. Furthermore, as it can also visualise the heart chambers, angiography can be used to detect and evaluate congenital cardiac defects [7]. In interventional radiology, it can be combined with intravascular obliteration in cases with well-defined tumour supply vessels [8].

However, angiography also has several disadvantages. One of the main issues is that angiography is an invasive procedure that carries some risk and considerable expense [6]. There is a risk of false-negative results, which could deny patients the necessary surgical intervention [6]. Additionally, in the use of the lower dimensional methods after a single injection of contrast medium, imaging is done from only one or two projections [5]. This means that the full extent of a vascular lesion may not be captured. Furthermore, the use of the contrast medium itself has to be considered a risk. It should not be given to people with kidney failure. Also, due to use of contrast agent it can also cause contrast-induced nephropathy in around 2% of patients [].

What is angioplasty?

Angioplasty, also known as percutaneous coronary intervention (PCI), is a procedure aiming to improve blood flow in coronary arteries after lumen restriction or blockage. They can become narrow or blocked due to the buildup of a sticky material called plaque or little emboli. This plaque is composed of cholesterol, calcium, and other substances in the blood and develops in late stage of atherosclerosis. Over time, it can narrow the arteries or fully block them, preventing certain parts of the heart from receiving enough oxygen rich blood leading to myocardial infarction [10].

During an angioplasty procedure, a small balloon is fitted to the tip of a catheter and inflated at the blockage site. By this, the plaque is pushed against the wall of the artery and the lumen is increased for the blood flow restored. After the artery has been widened, the balloon is deflated and withdrawn with the catheter. As the plaque still is in the artery a stent is placed to keep the occlusion open. The stent is a tiny wire-mesh tube and is the fasted and great long-term solution [11, 12, 13].

Angioplasty is used to treat acute coronary syndrome. Which typically has symptoms of chest pain caused by blockages in the coronary arteries. As it can limit damage to the heart during or right after a heart attack it is used as an emergency treatment. However, it's important to note that angioplasty treats the symptoms of CAD, but it does not cure it. To help prevent more plaque blockages and stop the development of the diseases, lifestyle changes such as smoking cessation, taking prescribed medicines, eating healthy foods, and getting regular exercise are necessary [10].

Advantages and disadvantages of angioplasty

Angioplasty has several advantages compared to other management methods in vascular occlusions. It is less invasive compared to coronary artery bypass surgery, and most patients are candidates for it. The infarct-related artery has 95–99% short-term patency rates, and over 90% of the time, a normal flow is restored. [14]. Also when compared to the thrombolysis angioplasty shows its superiority in achieving infarct artery patency, restoring normal coronary blood flow. Additionally, it is better for the prevention of temporary or permanent reocclusion [15]. This is supported by the fact that angioplasty results in lower rates of mortality, recurrent ischemia, or stroke than thrombolysis [15].

Another advantage of angioplasty is that it can be performed under local anesthesia, making it a good choice for high-risk surgical patients [16]. It also offers easier access to anatomically challenging lesions and a shorter length of hospital stay, which can reduce costs [16].

However, as good as angioplasty is it has its disadvantages. The major disadvantage is the frequent occurrence of restenosis after an initially successful procedure [17]. Restenosis, or the re-narrowing of the artery, occurs in about 30% of cases [18]. Because of the restenosis it can lead to the need for repeat interventions, which can increase the overall cost of treatment [19].

Another risk associated with angioplasty is the possibility of cerebral embolism. It can be caused by debris dislodgement during the catheter manipulation in the blood [16]. Other risks associated include bleeding, clotting, or bruising at the point of insertion. Inside the stent scar tissue or blood clots can form. As an interventional treatment angioplasty can cause an irregular heartbeat, damage to a blood vessel, heart valve, or artery, a heart attack, and kidney damage [20].

Angiography vs angioplasty

Angiography and angioplasty are two procedures used in the diagnosis and treatment of heart diseases, particularly coronary artery disease.

Angiography is a diagnostic procedure that uses X-ray imaging and contrast media to visualize the inside of blood vessels. It is mostly used in assessment of the arteries, veins, and heart chambers. In the vessels it helps to identify blockages in the coronary arteries and in the heart chambers it shows congenital defects. However, it can also show the perfusion of organs of the body, like the liver.

On the other hand, angioplasty is a therapeutic procedure. Not seldom it is performed after an angiography. Its goal is to restore the blood flow by widening blocked or narrowed arteries. The process involves the use of a balloon catheter. In some cases, a stent is placed to keep the artery open.

The choice between angiography and angioplasty depends on the patient's condition. Normally, in acute situations like in unstable angina both the procedures are performed. First to diagnose and then to treat as soon as possible to increase the health benefit for the patient [21].

Not only in terms of safety but also cost-effectiveness, combined coronary angiography and angioplasty can result in shorter hospital stays and lower overall costs [22]. This combined procedure has been used progressively more frequently over the years [23].