The difference between **angiography** and **CT angiography (CTA)** is in the procedure, accuracy, invasiveness, and the type of information they provide. In the following, we explain the key differences of these two medical imaging methods in a comparative manner **What is angiography?** **Angiography** is an advanced imaging method in medicine that is used to evaluate the **state of blood vessels**, especially in sensitive areas such as the heart, brain and organs. In this process, contrast material is injected into the vein so that the blood flow path can be clearly seen in the radiological images. In this way, doctors will be able to accurately diagnose vascular narrowing, blockage or abnormalities. Angiography is usually used to check cardiovascular diseases, stroke or organ failure. Despite its relatively minimal invasive nature, this method requires specialized equipment and post-treatment care. **What is CT angiography (CTA)?** **CT angiography (CTA)** is a non-invasive imaging method that allows accurate observation of the body's blood vessels using X-rays and contrast material. This method is usually used to check the vessels of the heart, brain, lungs and organs. Although CTA is generally considered safe, the use of contrast material can lead to **allergic reactions** or kidney damage in some patients. Also, there is a certain amount of radiation in this procedure that should be done with caution in certain individuals. It is necessary to evaluate the general condition of the patient before performing CTA. ### **method of performing angiography or CT angiography** - **classical angiography (heart angiography)** - It is an **invasive** method. - The catheter (thin tube) enters the artery through the groin or wrist and is guided to the heart. Then the contrast agent is injected and the imaging is done with a **fluoroscopy** (live X-ray) device. - **CT angiography (CTA)** - It is a **non-invasive** method. - The contrast material is injected intravenously (usually through the arm vein) and a **high-speed CT scan** machine is used to record images of the vessels. ### **Level of accuracy and application (angiography / CT angiography)** - **classical angiography** - Very high accuracy for detecting stenosis or **occlusion of heart vessels**. - Provides the possibility of **simultaneous treatment** (such as angioplasty and stent placement). - **CTA** - Useful for **initial examination** of vessels, especially in patients with moderate or low risk. - High accuracy, but in cases such as severe calcification, it may have limitations. - It is only **diagnostic**, not treatment. **When does the doctor recommend CT angiography (CTA)?** 1. **Preliminary examination of chest pain** in people who: - They have no history of heart disease - They have a low to moderate risk of heart disease 2. **Evaluation of coronary arteries** in those who: - Non-invasive tests (such as exercise test or echo) have uncertain results - They cannot do exercise test 3. **Checking the structure of other arteries** such as the renal, cerebral, cervical, or aorta arteries. 4. ** Screening of younger patients ** with mild or suspicious symptoms without severe risk factors. ### **When does the doctor recommend classical angiography?** 1. **accurate diagnosis in patients with clear symptoms of heart disease** such as: - Chest pain at rest - Clear changes in the ECG - Abnormal results in exercise test or echo - **When there is a possibility of needing immediate treatment (such as stenting)**, angiography allows treatment at the same time. - **In patients with a previous history of heart surgery or stent placement** who need a more detailed examination. - **When CTA does not give a definitive answer** or its images are not clear enough due to high pulse, calcification or artifacts. Here is a real example from a medical scenario to better understand the difference in decision-making between **CT angiography** and **classic angiography**: ### **Scenario 1: 45-year-old man with mild chest pain** - **History:** A 45-year-old man with a history of high blood pressure, but no history of heart disease. Sometimes he gets mild chest pain when he is stressed. - **Reviews:** - Normal ECG - Slightly abnormal exercise test - Relatively high cholesterol level - **Doctor's decision:** First, **CT angiography** is requested to perform an initial examination of the coronary arteries. If a marked stenosis is seen, it may be referred later to classic angiography for treatment. ### **Scenario 2: 65-year-old woman with chest pain and abnormal ECG** - **History:** A 65-year-old woman with a history of diabetes, hypertension, and chest pain at rest. ECG shows ischemia (anemia of the heart muscle). - **Reviews:** - Positive exercise test - Cardiac enzymes are slightly high - He has a family history of heart disease - **Doctor's decision:** Directly referred for **classical angiography** Because the probability of serious blockage is high and there is a possibility that **stent or therapeutic intervention** will be needed immediately. These two examples clearly show that the doctor decides which method is more appropriate according to the patient's age, symptoms, history, and initial tests. **after CT angiography (CTA)** CTA is a **non-invasive diagnostic procedure**, so the patient is usually discharged immediately after it is done. But depending on the result, the next steps are different: ### If the results are normal or without significant stenosis: - Only changes in lifestyle (diet, exercise, smoking cessation) - Blood pressure, blood fat, and sugar control - Periodic examinations (e.g., echocardiogram or echocardiogram every few months) ### If mild to moderate stenosis is seen: - Prescribing drugs such as aspirin, statin, beta blocker - Sports program under the supervision of a doctor - Continuous follow-up with a cardiologist (sometimes rechecking in a few months) ### If severe narrowing is seen in the main veins: - Referral to **classic angiography** for a more detailed examination and **probability of treatment (stent or bypass surgery)** **after classic angiography** Because this procedure is invasive, aftercare is more important: ### Immediate care after the procedure - a few hours of rest in the treatment center (usually 4-6 hours) - Checking the catheter insertion site (for bleeding or bruising) - Restriction of physical activity for 1 to 2 days ### Depending on the result of angiography: #### If there is no significant blockage: - The patient is discharged with medication (such as aspirin and statins) - Healthy lifestyle advice and regular follow-up #### If significant stenosis is seen: - At the same moment **stenting (angioplasty)** may be done - or in the case of several large blockages, planning for **heart bypass surgery** #### Follow-ups: - Long-term drugs (anti-platelet, fat-reducing, etc.) - Heart echo or exercise test to check heart function - Regular visits to a cardiologist Comparison table of measures after CTA and classical angiography ### Summary: - If there is a need for a detailed examination and **simultaneous treatment**, **classic angiography** is a better choice. - If the goal is only **initial vascular examination** and the patient has a low risk, **CT angiography** is faster and safer.