How can a heart catheterization determine whether or not I need a stent?

You may hear a heart catheterization also referred to as an angiogram, which is a test that allows doctors to see narrowed areas of the blood vessels on an x-ray after a special dye, called contrast dye, is injected into the arteries. Before your angiogram, your interventional cardiologist will discuss the procedure with you and discuss your treatment options if a severe blockage is discovered. With your prior consent, an interventional cardiologist may insert a stent to reopen any serious blockages that are discovered during the heart catheterization procedure.

If the pictures of your heart obtained from the angiogram suggest a blockage may be borderline and it is not clear that a stent would be of benefit to you, the interventional cardiologist may perform another test, such as intravascular ultrasound (IVUS), which uses sound waves to generate a highly detailed image of the inside of the artery, or fractional flow reserve (FFR), a test using a pressure sensitive wire that measures blood flow through the artery, to see if a stent is indicated.

On the other hand, if multiple serious blockages are discovered that would be better treated by redirecting blood flow around artery blockages, you may receive coronary artery bypass graft surgery, performed by a cardiovascular surgeon. This surgery involves taking a portion of a healthy artery or vein from elsewhere in your body and attaching it above and below the blockage in the coronary artery to provide a new path for blood flow. In certain situation, this may lead to a more complete and long-term treatment option, but studies continue to be performed to evaluate which patient might benefit most from angioplasty and stents versus coronary artery bypass surgery.