[Coronary angiography my false friend]

Abstract

Coronary angiography has been a long-standing friend since the first selective injection by Sones in 1958. More than 400,000 coronary angiographies are performed each year in France for the diagnosis and treatment of ischemic heart disease. In just over 60 years, examinations have become simpler, with imaging that has considerably progressed. Nevertheless, it remains an invasive and radiating examination and requires an injection of a potentially nephrotoxic contrast medium. It is a two-dimensional projection of a luminogram of small arteries, in perpetual movement. The technical realization must be perfect, the analysis of the images must be careful. It is important to be aware of the pitfalls and limitations of the examination, and to rely on complementary techniques to resolve ambiguities, whether functional (FFR, IMR) or morphological (IVUS, OCT). Although non-invasive explorations, such as coroscanner, are in full development, these alternative methods have other limitations (lack of resolution, artifacts related to calcifications) which mean that angiography often remains essential for the diagnosis of coronary artery disease, indispensable for deciding on treatment and guiding revascularization. All of these elements make coronary angiography the definition of a friend: someone you know well... but you love anyway.

Keywords: FFR; OCT endocoronaire; ambiguïtés morphologiques; coronarographie; coronary angiography; endocoronary OCT; limitations; limites; morphological ambiguities.