Pitfalls in the angiographic diagnosis of coronary artery disease

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As we carefully examine selective coronary arteriography in 1977, several things are conspicuous. The value of the procedure as a diagnostic tool is appreciated by increasing numbers of clinicians, cardiologists, and cardiac surgeons each year. This trend partially reflects the availability of adequately trained personnel who have clearly demonstrated that the procedure can be performed with an acceptable risk. The development of improved image intensifiers and other x-ray and photographic equipment has provided better image clarity of large and small structures. Consequently, a better diagnostic standard for defining the coronary artery circulation has evolved.

Although these changes in the past two decades represent progress in evolution, the different disciplines that have produced various standards in technique, selection, and utilization of equipment and experience in interpretation of data have been responsible for misinterpretation of the studies and latent errors. Inexperienced personnel have been a frequent cause of inept performance in catheter manipulation, placement of the catheter tip, selective catheterization, and opacification of the coronary arteries and cardiac chambers, and utilization of angiographic techniques that provide maximum information. Without adequate supervision, anomalies, variants of normal anatomy, or fixed and functional obstructions may not be recognized; with inadequate contrast visualization of the coronary artery circulation, various patterns of intracoronary and intercoronary collateral channels may not be identified.

Although it is known that the value of selective coronary arteriography as a diagnostic procedure depends heavily on the availability of equipment that will define the morphology of the coronary artery circulation, the inadequate use of . . .



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