Abstract The X-ray angiogram image denoising is always one of the most popular research in the field of computer vision. While the methods removed the noise, the useful structure (such as peripheral vascular) had also been smoothed, the fundamental reason is that the denoising methods cannot efficiently distinguish structural areas from flat areas. In this paper, we have proposed a spatially adaptive image denoising (SAID) method which contains two steps: spatially adaptive gradient descent (SAGD) image denoising and dual-domain filter (DDF). The SAGD denoising method contains the following parts: first of all, the wavelet shrinkage method is used to estimate redundant information which is composed of the noise and useful structures; secondly, according to the characteristic of second order matrix, a spatially adaptive gradient factor (SAGF) has been constructed to distinguish the structure from flat areas; finally, the SAGF replaces the original gradient factor and then the SAGD image denoising method is formed. To further improve the quality of the SAGD image, the SAGD image is re-denoised by a modified DDF which is guided with a rotationally invariant non-local filter (RINLF) in spatial domain and gets structural details by wavelet shrinkage in frequency domain. The results of simulation experiments verify that the proposed SAID method can get well quantitative and qualitative results which are even superior to those using the state-of-the-art denoising methods. Even more, the fluctuation of peak signal-to-noise ratio (PSNR) value is very small with a small disturbance of SAGF, which illustrates that our algorithm is more robust than the prior progressive image denoising (PID) method. Moreover, the comparison results of the extensive experiments on clinical X-ray cardiovascular angiogram images further illustrate that our method can yield clearer cardiovascular images which can provide more useful vascular information for clinicians to analyze and diagnose the cardiovascular diseases.