A cardiac catheterisation can determine whether you suffer from a narrowing of the coronary arteries (coronary heart disease). In addition, the pumping capacity of the heart is examined and heart valve defects can be further assessed. Coronary heart disease can be recognised by chest pain (angina pectoris) or shortness of breath under stress, but also by cardiac arrhythmia.

After local anaesthesia, a so-called sheath with a diameter of 2 mm is placed in the vessel. An artery at the wrist is preferably used as the access for coronary angiography, alternatively the inguinal vessel. The right and left coronary arteries are reached through differently preformed catheters. A contrast agent is administered and an X-ray film is taken at the same time. This makes it possible to assess whether there are stenoses in the coronary arteries or whether other causes are relevant to the symptoms.
If stenoses are present, we would like to treat them as soon as possible after discussing the findings with you. A vascular support (stent) is inserted into the vessel through the cardiac catheter, which keeps the vessel open in the long term. Drug-eluting stents have proven to be suitable for this treatment. If necessary, pre-dilation or post-dilation with a balloon catheter alone is carried out before inserting a stent in order to widen the constriction beforehand and enable the placement of a stent or to improve the result after stent implantation. In selected cases, magnesium-based bioresorbable stents can also be used.

In the case of very calcified vessels, so-called rotablation is performed, in which the calcium in the constrictions is removed using a diamond-tipped drill head. Drill heads ranging in size from 1.25 to 2.0 mm are available for this purpose. This is followed by stent implantation, possibly with renewed pre- or post-dilatation.

Chronic coronary artery occlusions are defined as an occlusion lasting more than 3 months in which there is no blood flow from the front into the vessel. Using special techniques and special recanalisation wires, such chronic vascular occlusions can now be reopened with a high success rate. This is followed by further stent implantation in combination with pre- and post-dilatation with a balloon catheter.

The so-called fractional flow reserve is used to determine the functional relevance of constrictions in the coronary arteries. For this purpose, the pressures in the vessels in front of and behind a constriction are registered during a cardiac catheterisation with the help of a special pressure wire (so-called intracoronary pressure measurement). This is done under resting conditions and under pharmacological hyperaemia during the intravenous administration of adenosine. The quotient between these two pressures upstream and downstream of the coronary constriction can be used to assess whether an intervention on this constriction is necessary by means of balloon dilatation and stent placement. The latest techniques make it possible to measure the flow reserve without administering adenosine, so that pharmacological side effects such as coughing or a slow pulse are no longer to be expected from this measurement. By determining the flow reserve, haemodynamic data can be used to assess whether stent implantation is advisable or not.

Both intravascular ultrasound (IVUS) and optical coherence tomography can be used for intracoronary imaging.
IVUS makes it possible to assess the narrowing from inside the vessel and provides information about the calcification and the true vessel diameter size. Interventions using intravascular ultrasound generally lead to a better selection of vascular supports and are associated with a lower subsequent rate of acute vascular occlusion (stent thrombosis) in international studies. Optical coherence tomography (OCT) has a better resolution than IVUS in the near-field range. For this imaging, contrast medium must be administered with each image to flush the vessel free of blood. Both OCT and IVUS make it possible to determine the exact vessel diameter and length of a lesion and thus help to optimise the interventional result.