Treatment: CAG and PCI

A CAG examination is an X-ray examination of coronary arteries. By injecting a contrast medium into the coronary arteries, it is possible to see what your coronary arteries look like. The contrast medium is harmless.

In some cases, a supplementary examination may be necessary to determine whether any narrowing requires treatment.

If you experience episodes of chest pain, this may be due to narrowing in your coronary arteries. This can be investigated with a CAG. If narrowing is found, you can be treated with a PCI.

During a PCI procedure, also known as balloon angioplasty, narrowing in the coronary arteries are widened. In most patients, small tube-shaped wire mesh structures (stents) are inserted to keep the coronary arteries open at the narrowed sites.

The primary aim of a PCI treatment is to eliminate episodes of chest pain (angina pectoris) by improving the blood supply to the heart.

If you experience chest pain due to narrowing of the coronary arteries, a PCI may help by improving the blood supply to your heart and eliminating these episodes.

Before your treatment, you will receive a letter informing you about fasting, medication, shaving and what to bring with you in connection with your treatment.

You are welcome to drive yourself or use public transport (including flights) the day after your examination or treatment.

On the day of your CAG examination or PCI procedure, a nurse will meet you. A plastic cannula will be inserted into a vein in your arm. Your blood pressure and pulse will be measured and an ECG will be taken. 

You will then have a consultation with the cardiologist before the examination/procedure.

As procedure times vary, you should expect to wait, which in some cases may be up to several hours. However, you will be treated on the same day.

Sedatives may be administered in the treatment room.

The examination/procedure will last between 30 minutes and one hour.

A local anesthetic is administered to the groin area. Once the anesthetic has taken effect, a thin plastic tube is inserted into the artery. A catheter is then guided through this tube and up through the artery to the heart.

Contrast medium is then injected into the catheter, spreading throughout the coronary arteries.

This process can be monitored on a TV screen, enabling the spread of the contrast medium through the coronary arteries to be observed.

If the coronary arteries appear healthy, the examination is complete.

However, if there are any narrowing, these can often be treated immediately using balloon angioplasty. A catheter containing a small balloon is inserted and inflated at the narrowed site. This widens the artery, resulting in better blood flow. You may experience brief, mild discomfort when the balloon is inflated. In most cases, a small tube-shaped wire mesh (stent) is inserted to maintain the widening of the blood vessel.

You may experience heart palpitations during the procedure. If this happens, it is important that you tell us, as we can relieve your discomfort.

In rare cases, the treatment may cause heart rhythm disturbances that require medical treatment or an electric shock to restore a normal heart rhythm.

The insertion site is sealed with a gel plug.

You will either walk or be wheeled to your room on the ward.

You can get up, eat and drink whenever you feel ready. If you have had a balloon angioplasty, you will need to stay in bed for one hour.

Please inform the nurse if you experience any discomfort, pain, a sensation of warmth or swelling in the groin.

In a small number of patients, bleeding from the groin may occur after the procedure, which will mean that you will need to stay in bed for longer. The bleeding will usually result in an accumulation of blood in the groin area. This may cause pressure over the following days, particularly when walking, but it will usually resolve itself.

Discharge

After the treatment, you and any relatives accompanying you will have a consultation with the cardiologist. You will be given a discharge letter.

We will send the discharge letter to your GP and the hospital that referred you.

If you have undergone balloon angioplasty, your local hospital's cardiac outpatient clinic will invite you for a follow-up appointment approximately one month after treatment. Following a routine coronary angiography, no further follow-up is scheduled.

Transport home

You are welcome to drive yourself or use public transport (including flights) the day after your examination or treatment.

Back home

For just under a week, you should take care to avoid physical activity, heavy lifting and climbing stairs in order to protect the insertion site in your groin.

Especially important following balloon angioplasty

If you have had a stent fitted, you may experience mild chest discomfort for up to one week after the procedure. You may take Paracetamol 1 g up to four times daily for this.

During the first week after the procedure, you may experience heart-cramp-like episodes, so you must avoid physical exertion.

You must take acetylic salicylic acid for the rest of your life.

If you are already taking Clopidogrel/Plavix or Brilique, you must continue taking the prescribed medication for the next six months.

If you are not already taking Clopidogrel/Plavix or Brilique, you should take one 75 mg Clopidogrel/Plavix tablet daily for the next six months.
Any exceptions to this will be stated in your discharge letter and discussed with your cardiologist.

See the information about Clopidogrel/Plavix below.

Information about Clopidogrel/Plavix/Brilique

Effect:
Clopidogrel, Plavix and Brilique are powerful blood-thinning medicines used to prevent blood clots in the heart. They work by inhibiting the tendency of blood platelets to clump together.

Complications

In rare cases, bleeding may occur in the groin area after discharge. Lie down on the floor and press firmly with your hands approximately 2 cm above the bleeding site. Ask a relative to help you if necessary.

If you experience any signs of infection in the groin after discharge, such as redness, swelling, pain or fever, you must contact your GP or the out-of-hours medical service.

In rare cases, severe chest pain may occur following stent treatment. In this case, you must call for emergency assistance on 112 immediately and you will need to be admitted to hospital for further examination.

Important: If you experience bleeding from the puncture site in your groin after returning home, or if you experience severe chest pain, you must call 112 for emergency assistance. You will then be admitted to hospital for further observation and treatment.