Diagnostic coronary arteriography in the interventional era: a combination of technical advancements, new mental attitude, and improved skill.

Over the past 20 years, coronary angiography has taken many important steps forward in enhancing its ability to detect coronary artery disease. The major improvements in techniques and materials for percutaneous transluminal coronary angioplasty and stenting have led to the progressively widespread use of percutaneous revascularization in an increasing number of patients, including complex and multi-vessel disease. It is commonly believed that this improved interventional prospect has changed the way diagnostic coronary artery angiography is performed among the invasive and interventional cardiology community. The complete development of the coronary tree with more angulated views, the use of intracoronary nitrates in cases of moderate stenosis or spastic coronary trees and adequate balloon and stent sizing, improved magnification of acquisition, when a precise assessment of bifurcation or ostial stenosis is required or when a stented coronary segment is evaluated, and finally an interventional mental attitude, are an integral part of the invasive cardiologist's tools and skills matching the major technical improvements in equipment and materials.