1
|
Di Mario C, Mashayekhi KA, Garbo R, Pyxaras SA, Ciardetti N, Werner GS. Recanalisation of coronary chronic total occlusions. EUROINTERVENTION 2022; 18:535-561. [PMID: 36134683 DOI: 10.4244/eij-d-21-01117] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Percutaneous treatment of coronary chronic total occlusions (CTO) has advanced greatly since its advent in the late 1970s through the development of dedicated wires and microcatheters, the improved skills of highly experienced operators and the adoption of new sophisticated strategies to guide procedural planning. The contemporary procedural success rate is 80-90% with a reduction in complications. Although there has been no improvement in prognosis in randomised trials to date, they, and other controlled registries of thousands of patients, confirm the pivotal role of CTO recanalisation in the treatment of angina and dyspnoea and an improvement in quality of life. Despite this evidence, CTO recanalisation is grossly underutilised. This review reports a detailed overview of the history, indications and treatment strategies for CTO recanalisation and hopes to increase interest among new, and especially young, operators in this demanding, rapidly evolving field of interventional cardiology.
Collapse
Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Kambis A Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Roberto Garbo
- GVM Care & Research, Maria Pia Hospital, Turin, Italy
| | | | - Niccolò Ciardetti
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Gerald S Werner
- Department of Cardiology, Klinikum Darmstadt GmbH, Darmstadt, Germany
| |
Collapse
|
2
|
Fukuda A, Ichikawa N, Hayashi T, Lin PJP, Matsubara K. Reducing stray radiation with a novel detachable lead arm support in percutaneous coronary intervention. J Appl Clin Med Phys 2022; 23:e13763. [PMID: 36001385 PMCID: PMC9588269 DOI: 10.1002/acm2.13763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 07/29/2022] [Accepted: 08/06/2022] [Indexed: 11/28/2022] Open
Abstract
Background Placing radioprotective devices near patients reduces stray radiation during percutaneous coronary intervention (PCI), a promising technique for treating coronary artery disease. Therefore, lead arm support may effectively reduce occupational radiation dose to cardiologists. Purpose We aimed to estimate the reduction of stray radiation using a novel detachable lead arm support (DLAS) in PCI. Materials and methods A dedicated cardiovascular angiography system was equipped with the conventional 0.5‐mm lead curtain suspended from the table side rail. The DLAS was developed using an L‐shaped acrylic board and detachable water‐resistant covers encasing the 0.5‐, 0.75‐, or 1.0‐mm lead. The DLAS was placed adjacent to a female anthropomorphic phantom lying on the examination tabletop at the patient entrance reference point. An ionization chamber survey meter was placed 100 cm away from the isocenter to emulate the cardiologist's position. Dose reduction using the L‐shaped acrylic board, DLAS, lead curtain, and their combination each was measured at five heights (80–160 cm in 20‐cm increments) when acquiring cardiac images of the patient phantom with 10 gantry angulations, typical for PCI. Results Median dose reductions of stray radiation using the L‐shaped acrylic board were 9.0%, 8.8%, 12.4%, 12.3%, and 6.4% at 80‐, 100‐, 120‐, 140‐, and 160‐cm heights, respectively. Dose reduction using DLAS with a 0.5‐mm lead was almost identical to that using DLAS with 0.75‐ and 1.0‐mm leads; mean dose reductions using these three DLASs increased to 16.2%, 45.1%, 66.0%, 64.2%, and 43.0%, respectively. Similarly, dose reductions using the conventional lead curtain were 95.9%, 95.5%, 83.7%, 26.0%, and 19.6%, respectively. The combination of DLAS with 0.5‐mm lead and lead curtain could increase dose reductions to 96.0%, 95.8%, 93.8%, 71.1%, and 47.1%, respectively. Conclusions DLAS reduces stray radiation at 120‐, 140‐, and 160‐cm heights, where the conventional lead curtain provides insufficient protection.
Collapse
Affiliation(s)
- Atsushi Fukuda
- Department of Radiological Sciences, School of Health Sciences, Fukushima Medical University, Fukushima, Fukushima, Japan
| | - Nao Ichikawa
- Department of Radiological Technology, Faculty of Health Science, Kobe Tokiwa University, Kobe, Hyogo, Japan
| | - Takuma Hayashi
- Department of Radiation Oncology, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Pei-Jan P Lin
- Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Kosuke Matsubara
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| |
Collapse
|
3
|
Lefèvre T, Mangiameli A, Hovasse T, Louvard Y, Benamer H, Garot P, Unterseeh T, Champagne S, Tavolaro O, Amelot S, Chevalier B. On-line estimated peak skin dose during percutaneous coronary intervention for chronic total occlusion using new patient dose mapping technology. Arch Cardiovasc Dis 2022; 115:436-447. [PMID: 35840491 DOI: 10.1016/j.acvd.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND X-ray exposure during complex percutaneous coronary intervention is a very important issue. AIM To reduce patient peak skin dose during percutaneous coronary intervention procedures for chronic total occlusion using on-line estimated peak skin dose software (Dose Map). METHODS Throughout the procedure, Dose Map provided a map of local cumulative peak skin dose. This map was displayed in-room from 1Gy cumulative air kerma, and was updated every 0.5Gy. The operator's actions to minimize deterministic risks following map notification were collected. Skin reaction was evaluated 3 months after the procedure. A comparison with our historical X-ray exposure data (207 patients from January 2013 to July 2014) was performed. RESULTS From November 2015 to October 2016, 97 patients (Japanese chronic total occlusion score 2.1±1.1; 100 percutaneous coronary intervention procedures for chronic total occlusion) were prospectively enrolled. Fluoroscopy time was 40.8 (21.6-60.3) minutes, cumulative air kerma 1884 (1144-3231) mGy, estimated peak skin dose 962 (604-1474) mGy and kerma area product 115.8 (71.5-206.7) Gy.cm2. Cumulative air kerma was>3Gy in 28% of cases, and>5Gy in 11% of cases. In 68% of cases, at least one action was taken by the operator after map notification to optimize skin dose distribution. Main changes included: gantry angulation (52%); field of view (25%); and collimation (13%). No skin injuries were observed at follow-up. In comparison with our chronic total occlusion historical radiation data, median cumulative air kerma and kerma area product were reduced by 31% and 33%, respectively (P<0.005. CONCLUSION Online skin dose mapping software allows the distribution of patient skin dose during complex percutaneous coronary intervention procedures, and may minimize X-ray exposure.
Collapse
Affiliation(s)
- Thierry Lefèvre
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France.
| | - Andrea Mangiameli
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France
| | - Thomas Hovasse
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France
| | - Yves Louvard
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France
| | - Hakim Benamer
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France
| | - Philippe Garot
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France
| | - Thierry Unterseeh
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France
| | - Stéphane Champagne
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France
| | - Oscar Tavolaro
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France
| | | | - Bernard Chevalier
- Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Ramsay Santé, 6 avenue du Noyer Lamber, 91300 Massy, France
| |
Collapse
|
4
|
Wilson-Stewart KS, Fontanarosa D, Malacova E, Trapp JV. Impact of dose reducing software on patient and staff temple dose during fluoroscopically guided pacemaker insertion, closure devices implantation and coronary angiography procedures. Phys Eng Sci Med 2022; 45:589-599. [PMID: 35532868 PMCID: PMC9239962 DOI: 10.1007/s13246-022-01126-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/03/2022] [Indexed: 11/03/2022]
Abstract
AbstractThe aim of this study is to investigate the effectiveness of dose reducing software (ClarityIQ) on patient and staff dose during fluoroscopically guided cardiac procedures. Dose measurements were collected in a room without dose reducing software (n = 157) and compared with similar procedures performed in two rooms with the software (n = 1141). Procedures included diagnostic coronary angiography, percutaneous coronary intervention, deployment of cardiac closure devices (for occlusion of atrial septal defect, patent foramen ovale, and atrial appendage) and insertion of permanent pacemakers. The dose reducing software was found to be effective in reducing patient and staff dose by approximately 50%. This study has added to the limited literature reporting on the capability of dose reducing software to decrease radiation exposure during the implantation of cardiac closure devices, as well as demonstrating a reduction in dose to the cardiologist and nursing staff. Administrators should ensure timely upgrades to angiographic equipment to safeguard patients and staff against the potentially adverse effects of radiation exposure. Regardless of the use of dose reducing software, the mean occupational dose during closure devices was in descending order scout > scrub > cardiologist. Scrub nurse dose was found to be higher than the cardiologist during closure devices (0.98/0.26 μSv) and diagnostic coronary angiograms (1.51/0.82 μSv). Nursing staff should be aware that their levels of radiation dose during some cardiac procedures may come close to or even exceed that of the cardiologist.
Collapse
|
5
|
Update on chronic total occlusion percutaneous coronary intervention. Prog Cardiovasc Dis 2021; 69:27-34. [PMID: 34826426 DOI: 10.1016/j.pcad.2021.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/14/2021] [Indexed: 11/22/2022]
Abstract
Chronic total occlusion (CTO) percutaneous coronary interventions (PCI) can be challenging to perform. The main indication for CTO PCI is to improve symptoms. Several contemporary studies have reported high CTO PCI success rates at experienced centers but success rates in all-comer registries remain low. Several scores can estimate the difficulty and the likelihood of success of CTO PCI. Dual arterial access and use of CTO crossing algorithms can improve the success and safety of CTO PCI. Intracoronary imaging can optimize stent expansion and minimize adverse cardiovascular events. While complications are more common in CTO PCI, careful planning and prompt diagnosis and treatment can prevent them or minimize their adverse consequences. In this article, we review contemporary data on the indications, safety and efficacy of CTO PCI.
Collapse
|
6
|
Januszek RA, Bryniarski L, Siudak Z, Malinowski KP, Surowiec S, Bryniarski K, Jędrychowska M, Wańha W, Bartuś K, Wojakowski W, Wójcik J, Legutko J, Surdacki A, Bartuś S. Predictors and trends of contrast use and radiation exposure in a large cohort of patients treated with percutaneous coronary interventions: Chronic total occlusion analysis based on a national registry. Cardiol J 2021; 30:VM/OJS/J/74257. [PMID: 34642921 PMCID: PMC10713226 DOI: 10.5603/cj.a2021.0124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/19/2021] [Accepted: 07/15/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim herein, was to assess predictors and current trends of radiation exposure and total contrast amount use in patients treated with percutaneous coronary intervention within chronic total occlusion (CTO PCI) and non-CTO PCI. METHODS Based on a nationwide registry (ORPKI), 535,857 patients treated with PCI between 2014 and 2018 were analysed. The study included 12,572 (2.34%) patients treated with CTO PCI. The CTO PCI and non-CTO PCI groups were compared before and after propensity score matching (PSM). Multifactorial mixed regression models were used to assess predictors of contrast amount use and radiation exposure. RESULTS The mean total contrast dose and radiation exposure decrease reached statistical significance in following years for the CTO PCI (p = 0.002 and p < 0.001) and non-CTO PCI groups (p < 0.001 and p < 0.001). Multifactorial analysis revealed that non-CTO PCI was a strong independent predictor of lower total contrast dose (estimate: -17.41; 95% confidence interval [CI]: -18.45 to -16.49, p < 0.001) and radiation exposure (estimate: -264.28; 95% CI: -273.75 to -254.81, p < 0.001). After PSM, it was confirmed that CTO PCI was an independent predictor of greater radiation exposure (estimate: 328.6; 95% CI: 289.1-368.1; p < 0.001) and total contrast dose (estimate: 30.5; 95% CI: 27.28-33.74; p < 0.001). CONCLUSIONS Contrast dose and radiation exposure have decreased in previous years with regard to the CTO PCI and non-CTO PCI groups. CTO PCI was found to be an independent predictor of greater total contrast dose and radiation exposure in the overall group of patients treated with PCI.
Collapse
Affiliation(s)
- Rafał A Januszek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.
- Department of Clinical Rehabilitation, University of Physical Education, Krakow, Poland.
| | - Leszek Bryniarski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Zbigniew Siudak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | | | - Sławomir Surowiec
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Krzysztof Bryniarski
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Magdalena Jędrychowska
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Jarosław Wójcik
- Department of Cardiology, Hospital of Invasive Cardiology IKARDIA, Nałęczów, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Andrzej Surdacki
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
- Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
7
|
Moroni F, Santiago R, DI Pietro R, Calcagno S, Azzalini L. Complications during chronic total occlusion percutaneous coronary intervention: a sign- and symptom-based approach to early diagnosis and treatment. Minerva Cardiol Angiol 2021; 69:773-786. [PMID: 34338491 DOI: 10.23736/s2724-5683.21.05831-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Coronary chronic total occlusions (CTO) are frequently found in patients undergoing coronary angiography. Despite their high prevalence and indication for revascularization in a relevant proportion of cases, CTO recanalization is attempted only in a minority of cases. This is due to higher risk of procedural complications compared to non-CTO interventions and because the CTO-PCIs are the most complex procedures in interventional cardiology. In particular, the perceived higher risk of complications during CTO intervention might discourage new operators from engaging in this challenging field. The aim of this work is to review the potential complications of CTO percutaneous coronary intervention, and to provide an algorithmic, sign- and symptom-based approach to facilitate early recognition and effective management.
Collapse
Affiliation(s)
- Francesco Moroni
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA.,Università Vita-Salute San Raffaele, Milan, Italy
| | - Ricardo Santiago
- PCI Cardiology Group and Bayamon Heart & Lung Institute, Bayamon, Puerto Rico
| | | | - Simone Calcagno
- Interventional Cardiology Unit, SM Goretti Hospital, Latina, Italy
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA -
| |
Collapse
|
8
|
Balter S, Moses JW. Achieving radiation reduction by adapting to technology advances. Catheter Cardiovasc Interv 2021; 97:1207-1208. [PMID: 33974746 DOI: 10.1002/ccd.29735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Stephen Balter
- Department of Radiology, Columbia University Medical Center, New York, New York, USA.,Department of Medicine, Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Jeffrey W Moses
- Department of Medicine, Cardiology, Columbia University Medical Center, New York, New York, USA.,Department of Medicine, St Francis Heart Center, Roslyn, New York, USA
| |
Collapse
|
9
|
Karacsonyi J, Vemmou E, Nikolakopoulos I, Ungi I, Abi Rafeh N, ElGuindy A, Azzalini L, Burke MN, Brilakis ES. Current challenges and prevention strategies for chronic total occlusion (CTO) complications. Expert Rev Cardiovasc Ther 2021; 19:337-347. [PMID: 33730518 DOI: 10.1080/14779072.2021.1905521] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) can be challenging, but high success rates (85-90%) are currently achieved at experienced centers with approximately 3% risk for a major periprocedural complication.Areas covered: CTO PCI complications can be categorized according to location such as cardiac and non-cardiac (vascular access complications, thromboembolic complications, contrast-related and radiation injury) complications. Cardiac complications are further subdivided into coronary (acute closure, perforation, and equipment loss or entrapment) and non-coronary (hypotension, myocardial infarction, tamponade, arrhythmias).Expert opinion: In this article, we review strategies to prevent and treat CTO PCI complications. Careful monitoring throughout the case enables prevention and early detection of a complication. If a complication occurs, rapid implementation of treatment using an algorithmic approach can minimize its adverse impact.
Collapse
Affiliation(s)
- Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Evangelia Vemmou
- Minneapolis Heart Institute and Minneapolis Heart Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Ilias Nikolakopoulos
- Minneapolis Heart Institute and Minneapolis Heart Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Imre Ungi
- Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | | | - Ahmed ElGuindy
- Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute and Minneapolis Heart Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
| |
Collapse
|
10
|
Werner GS, Yaginuma K, Koch M, Tischer K, Silber M, Werner J, Keuser T, Moehlis H. Reducing fluoroscopic and cineangiographic contribution to radiation exposure for chronic total coronary occlusion interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:58-64. [PMID: 33931375 DOI: 10.1016/j.carrev.2021.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The treatment of chronic total coronary occlusions (CTO) carries the highest radiation exposure among percutaneous coronary interventions (PCI). In order to minimize radiation damage, we need to understand and optimize the contribution of all components of radiation exposure. METHODS A total of 1000 CTO procedures performed between 2011 and 2020 were compared according to implemented radiation modifications. Group 1 used the original set-up of the X-ray equipment (Artis Zee, Siemens). In group 2 a modified protocol aimed at reducing the fluoroscopy exposure, in group 3 further modifications aimed at reducing cineangiographic exposure. RESULTS Despite an increased lesion complexity, Air Kerma (AK) was reduced from 2619 mGy (1653-4574) in group 1 to 2178 mGy (1332-3500; p < 0.001) in group 2 by mainly reducing fluoroscopic contribution by 54.1%, the cineangiographic contribution was lowered by only 6.6%. In group 3 AK dropped drastically to 746 mGy (480-1225; p < 0.001) mainly by reducing the cineangiographic contribution by 53.4%, still there was a further reduction of fluoroscopy contribution of 8.2%. This also led to a reduction of the skin entry dose from 1038 mGy (690-1589) in group 2 to 359 mGy (204-591; p < 0.001) in group 3. This was achieved both in normal weight and obese patients, and both in antegrade and retrograde procedures. CONCLUSIONS The present study demonstrates that by modifying both the fluoroscopic and cineangiographic contribution to radiation exposure a drastic reduction of radiation risk can be achieved, even in obese patients. Currently accepted radiation thresholds may no longer be a limit for CTO PCI.
Collapse
Affiliation(s)
- Gerald S Werner
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany.
| | - Kenji Yaginuma
- Department of Cardiology, Juntendo University Urayasu Hospital, Tokyo, Japan
| | - Matthias Koch
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | | | - Martin Silber
- Institut für Radioonkologie und Strahlentherapie, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Juliane Werner
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Thomas Keuser
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Hiller Moehlis
- Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany
| |
Collapse
|