Dr Sukhjinder Nijjer
Consultant Cardiologist
Expert in Coronary Angiography & Angioplasty
Procedure — Coronary Intervention
Coronary Angiography
& Angioplasty
Coronary angiography is the gold-standard test for assessing the heart arteries. When a significant blockage is found, angioplasty — opening the artery with a balloon and stent — can relieve symptoms and prevent a heart attack.
The Gold-Standard Test
Coronary Angiography
Coronary angiography is the definitive test for assessing the coronary arteries — the vessels that supply blood to the heart muscle. It is typically performed when non-invasive tests suggest the possibility of coronary artery disease, or when symptoms of chest pain or breathlessness remain unexplained.
The procedure is performed in a hospital catheter laboratory, usually as a day case. Light sedation may be used but a general anaesthetic is not required. You will fast beforehand, though a prolonged fast is not necessary — Dr Nijjer will advise on the exact duration.
A small tube (catheter) is passed to the heart arteries via the wrist (radial approach) or, less commonly, the upper groin (femoral approach). X-ray contrast dye is injected into the coronary arteries so they can be seen clearly on screen. A typical study takes 10–15 minutes.
Step by Step
How the Procedure Works
Preparation & Access
A small puncture is made at the wrist (radial) or groin (femoral). A thin plastic sheath is inserted into the artery.
Catheter Placement
A flexible catheter is guided through the artery to the opening of each coronary artery. You will not feel this.
Contrast & Imaging
X-ray contrast dye is injected. The coronary arteries show up on a live X-ray screen, revealing any narrowings or blockages.
Assessment
Dr Nijjer assesses each artery, measuring narrowings and using pressure wires or imaging catheters where needed.
Treatment or Discharge
If a stent is needed it can often be placed at the same sitting. Most patients go home the same day.
Indications
When Is Angiography Needed?
Angiography is recommended when there is a clinical concern about blood supply to the heart — whether from symptoms, abnormal test results, or an acute presentation.
Stable Angina
Chest discomfort during exertion caused by a significant narrowing restricting blood flow. Angiography confirms the location and severity. Stenting can relieve symptoms where medications are insufficient.
Heart Attack (STEMI / NSTEMI)
A sudden complete or partial blockage of a coronary artery requires urgent angiography to identify and open the blocked vessel, limiting permanent damage to the heart muscle.
Abnormal Non-Invasive Tests
A positive exercise stress test, stress echocardiogram, or CT coronary angiogram may suggest significant disease that warrants direct assessment and potential treatment.
Treatment
Coronary Angioplasty & Stenting
When there is significant ischaemia (insufficient blood supply) or an acute blockage, the narrowing can be treated by placing a coronary stent — a small metallic mesh structure that holds the artery open.
A thin guidewire is first advanced through the narrowing. A balloon catheter is then passed over the wire and inflated to compress the plaque. The stent — crimped onto the balloon — is deployed and expands to scaffold the artery wall. The balloon is removed, leaving the stent permanently in place.
Dr Nijjer uses pressure wires and intravascular imaging to ensure each stent is placed precisely where it will deliver the greatest benefit. In most cases the procedure is done under local anaesthetic with light sedation, through the wrist, and patients go home the same day. Complex cases may require an overnight stay.
Dr Nijjer's Specialist Expertise
Advanced Techniques
Not all angioplasty procedures are straightforward. Complex cases — heavily calcified arteries, long diffuse disease, or multi-vessel involvement — require specialist skills and technology. Dr Nijjer is trained and experienced in the full range of advanced coronary intervention techniques.
Physiology
iFR & Pressure Wire
iFR (Instantaneous wave-Free Ratio) is a pressure wire measurement that tells Dr Nijjer whether a narrowing is actually restricting blood flow — and therefore whether a stent will help. Dr Nijjer co-developed this technology, which is now used in tens of thousands of patients worldwide and embedded in international guidelines.
Imaging
IVUS & OCT
Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) are miniature imaging catheters that travel inside the coronary artery, providing cross-sectional images with far greater detail than angiography alone. They guide optimal stent sizing and confirm complete expansion.
Calcium Modification
Shockwave & Rotablation
Heavily calcified arteries cannot be adequately expanded with a standard balloon. Shockwave intravascular lithotripsy uses acoustic pressure waves to crack calcium. Rotational and orbital atherectomy use rotating burrs to debulk calcified plaque before stenting.
Calcium & Complex Disease
Laser Atherectomy
Excimer laser coronary atherectomy uses ultraviolet light energy to ablate calcified or fibrotic plaque and is used in complex anatomies where conventional techniques are limited.
Physiology
Angiography-Derived Physiology
Advanced computational analysis of the angiogram images can derive physiological pressure measurements without requiring a separate pressure wire, streamlining the assessment of multiple lesions in the same procedure.
Microvascular Disease
Microvascular Assessment
Some patients have angina despite no significant blockages. Dr Nijjer assesses the small coronary vessels for microvascular dysfunction, epicardial vasospasm, and myocardial bridging — conditions often missed by conventional angiography alone.
After Stenting
Medications After Your Procedure
Following coronary stent placement, blood-thinning medications are essential to prevent the stent from clotting. These must be taken reliably and must never be stopped without checking with Dr Nijjer first.
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Aspirin 75mg daily
Prescribed to most patients with significant coronary artery disease. Reduces platelet activity and lowers the risk of further clot formation. Taken indefinitely.
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Clopidogrel 75mg daily
The standard second antiplatelet agent after elective stenting. Combined with aspirin to prevent stent thrombosis. Usually continued for 12 months, sometimes longer.
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Ticagrelor or Prasugrel
Used after a heart attack in place of clopidogrel. More potent antiplatelet effect reduces the risk of further events in patients who have experienced an acute coronary syndrome.
If antiplatelet medications are missed, a stent can clot suddenly (stent thrombosis) — a life-threatening emergency. If another doctor suggests stopping these medicines before a procedure, they should consult with Dr Nijjer first.
I had been having central chest tightness for some time. I called Dr Nijjer and saw him straight away. He organised tests showing I likely had blocked arteries. Because I kept having chest pain, Dr Nijjer performed an angiogram through my hand. I needed two stents and have felt so much better. I know I am in good hands.
Mr K.S.G.
Business Owner — Patient of Dr Nijjer
Related Conditions
Further Reading
Concerned about your coronary arteries?
Dr Nijjer performs coronary angiography and complex angioplasty at Hammersmith Hospital and across his private clinic network. If you have been advised to consider angiography, or are experiencing chest pain, arrange an expert assessment today.