Angiography

‘As an aid to diagnosis in ischaemic heart-disease’, Lancet editorialists wrote in 1966, coronary angiography ‘seems at present to offer little that cannot be more easily obtained by much simpler methods, such as good history-taking and electrocardiography’. Since its serendipitous origins at the Cleveland Clinic laboratory of Dr F. Mason Sones in 1958, selective coronary angiography has taken on central importance in the diagnosis of coronary artery disease and characterization of coronary anatomy prior to coronary artery bypass graft surgery. Performance has become simpler and safer, evolving from a brachial artery cut-down approach with stiff, large-calibre multipurpose catheters to percutaneous femoral, radial, and now ulnar approaches with softer, lower-profile catheters specially designed to atraumatically engage the coronary ostia.