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Cardiac Catheterization


Executive Summary

  1. Cardiac catheterization is a procedure to examine how well the heart is functioning. The liquid dye injection or coronary angiography is done after the tube is inserted into artery that leads to the heart. This tests the blood flow and shows where the artery is blocked. The procedure is recommended for patients exhibiting heart disease symptoms.
  2. If a narrowing of the coronary arteries is detected, a percutaneous coronary intervention and stent will be administered in the same session.
  3. Medical treatment and regular follow up with cardiologist.

What is cardiac catheterization?
Cardiac catheterization is a procedure that allows a doctor to diagnose heart disease. This procedure can be performed under local anesthesia. It involves the insertion of a thin flexible tube (catheter) into a chamber of the heart via an artery in the groin or wrist by using contrast media (special type of dye) to assess the coronary artery, the blood vessel that supplies oxygen and nutrient to the heart muscles.

Who should undergo cardiac catheterization?
A cardiologist will advise whether a patient should undergo cardiac catheterization based on the identified symptoms, such as unexplained chest pain or abnormal results of an exercise stress test or electrocardiogram. These conditions usually occur in patients with coronary artery disease caused by an accumulation of fatty materials on the inner linings of the arteries and the resulting blockage restricts blood flow to the heart. Patients suffering from chest pain, exhaustion and pulmonary edema should receive an additional examination to ensure accurate diagnosis and prompt treatment.

Percutaneous coronary intervention
From the coronary angiography (liquid dye injection), if a narrowing of the coronary arteries is detected, a percutaneous coronary intervention and stent will be administered in the same session. The insertion of a stent (mesh tube) is used to treat narrowed coronary arteries and prevent constriction. It is a permanent implant. There are 3 kinds of stents as follows:

1. Bare-metal stent
Some patients may experience a recurrence of the condition following the application of a bare- metal stent. However, the recurrence rate for bare-metal stent is lower than for balloon angioplasty alone. The mechanism of restenosis after bare-metal stent application is due to the development of lipid-rich plaque and fibrin deposition inside the bare-metal stent. Generally, this recurrence occurs in approximately 15-20% of patients.

2. Drug-eluting stent
A drug-eluting stent can reduce restenosis by 3-8%. The doctor may insert the drug-eluting stent in patients who have higher restenosis rates, such as patients with diabetes.

3. Bioresorbable Vascular Scaffold (BVS)
The Bioresorbable Vascular Scaffold (BVS) represents a new treatment option for coronary artery disease. It is similar to the drug-eluting stent, but dissolvable. It is made of polylactide, which has been used in other dissolvable medical devices, such as dissolving stitches. There are several benefits associated with the BVS. The patients do not have to undergo long-term treatment with anti-platelet medications because the BVS is resorbed within 3 years. The patients, therefore, do not need to worry about stent thrombosis after discontinuing anti-platelet medications.

Benefits of Cardiac Catheterization
Cardiac catheterization provides accurate diagnosis and gives immediate results after the contrast media is injected. If a narrowing of the coronary arteries is detected, the doctor can provide treatment immediately. It is a non-surgical treatment that can be performed while the heart still beats by using a local anesthetic to numb the insertion site without the need for a general anesthetic. The risk of cardiac catheterization is only 1% and the patients will recover within 1-2 days. If there are no complications, they can then return to their daily activities.
Cardiac catheterization can be used to treat the following congenital heart conditions or defects without the need for surgery:
– Closure device of atrial septal defect (ASD) or a hole in the heart
– Dilatation of congenital valve disease
– Dilatation of mitral stenosis (a narrowing of the mitral valve), especially rheumatic heart disease
– Dilatation of severe aortic stenosis at high risk for valve replacement, etc.

In addition to the treatment of coronary arteries, cardiac catheterization is used to treat peripheral artery disease.
Peripheral artery disease is a condition in which fatty patches or plaque develop within the inside lining of the arteries, causing the inflammation of body tissues and fibrosis in the area, leading to a narrowing of the arteries. This is called artherosclerosis. When the arteries become blocked, the blood supply is restricted to the end-organ. This condition generally occurs in elderly patients and people who smoke, have diabetes, high blood pressure and high blood cholesterol diseases such as peripheral artery disease (PAD). The condition can be treated by balloon angioplasty, similar to coronary artery treatment. Cardiac catheterization is a good treatment option for peripheral artery disease due to it being a non-invasive procedure. Generally, the patients do not need a general anesthetic. The procedure is performed in the arteries of the legs with the need for only a 1.6 mm incision in the groin. The incision will be sealed within 6-8 hours. The patients are hospitalized and observed for only 1 day. If there are no complications, the patients can then go home.

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