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Chen SX, Zhang B, Hao YX, Xiao H. Comparison of Distal Transradial and Femoral Access in Endovascular Treatment of Non-coronary Arterial Disease. Angiology 2024; 75:556-564. [PMID: 36919369 DOI: 10.1177/00033197231163358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
This study compared the efficacy and safety of distal transradial access (dTRA) and common femoral artery access (CFA) for endovascular treatment of non-coronary arterial disease. 102 interventions were divided into dTRA (n = 51) and CFA (n = 51) groups; the puncture success rate was 100% in both groups. The mean number of punctures and puncture time were greater in the dTRA than CFA group (1.86 vs 1.04 and 3.96 vs ≤1.00 min, p < .001 for both), whereas the access-related complication rate was comparable. The surgical success rate was higher in the CFA than dTRA group (98.0 vs 84.3, p = .036), and the operative time was longer in the dTRA than CFA group (99.09 vs 84.10 min, p = .017). The postoperative adverse event rate was not different between the dTRA and CFA groups. dTRA is a safe and feasible access for non-coronary arterial disease and is comparable to CFA in terms of puncture success, access-related complications, and major adverse events. The dTRA is inferior to CFA in the treatment of lower extremity arterial disease. Due to the increase in the operation time and the contrast medium volume in the dTRA, it is necessary to be vigilant about contrast nephropathy and late radiological random side effects.
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Affiliation(s)
- Shang-Xiong Chen
- Department of Vascular Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Bin Zhang
- Department of Vascular Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Ying-Xue Hao
- Department of Vascular Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Hang Xiao
- Department of Vascular Surgery, Southwest Hospital, Army Medical University, Chongqing, China
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Tamirisa KP, Alasnag M, Calvert P, Islam S, Bhardwaj A, Pakanati K, Zieroth S, Razminia M, Dalal AS, Mamas M, Russo AM, Kort S. Radiation Exposure, Training, and Safety in Cardiology. JACC. ADVANCES 2024; 3:100863. [PMID: 38939686 PMCID: PMC11198606 DOI: 10.1016/j.jacadv.2024.100863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 06/29/2024]
Abstract
Exposure to ionizing radiation is an inherent occupational health hazard in clinical cardiology. Health risks have been reported previously, including predilection to cancer. In addition, orthopedic injury due to prolonged wearing of heavy protective lead aprons, which are mandatory to reduce radiation risk, have been extensively documented. Cardiology as a specialty has grown with rising volumes of increasingly complex procedures. This includes electrophysiological, coronary, and structural intervention, advanced heart failure/transplant management, and diagnostic imaging. Both the operator as well imaging specialists are exposed to radiation, particularly in structural interventions where interventional cardiologists and structural imagers work closely. Increasingly, women interested in cardiology may deselect the field due to radiation concerns. This expert document highlights the risks of radiation exposure in cardiology, including practical tips within various subspecialty fields such as interventional/structural cardiology, electrophysiology, imaging, advanced heart failure, and pediatric cardiology.
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Affiliation(s)
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Peter Calvert
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Sabrina Islam
- Section of Cardiology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Anju Bhardwaj
- Advanced Cardiopulmonary Therapies and Transplantation, University of Texas/McGovern Medical School, Texas Medical Center, Houston, Texas, USA
| | - Keerthana Pakanati
- Center for Cardiovascular Health, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Shelley Zieroth
- Department of Cardiology, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | | | - Aarti S. Dalal
- Division of Cardiology, Department of Pediatrics, Vanderbilt Medical Center, Nashville, Tennessee, USA
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK
| | - Andrea M. Russo
- Division of Cardiology, Cooper University Hospital, Camden, New Jersey, USA
| | - Smadar Kort
- Department of Cardiology, Stony Brook Heart Institute, Stony Brook, New York, USA
| | - ACC Women in Cardiology Advocacy Work Group
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Section of Cardiology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
- Advanced Cardiopulmonary Therapies and Transplantation, University of Texas/McGovern Medical School, Texas Medical Center, Houston, Texas, USA
- Center for Cardiovascular Health, Virginia Mason Franciscan Health, Seattle, Washington, USA
- Department of Cardiology, St. Boniface Hospital, Winnipeg, Manitoba, Canada
- Amita St. Joseph Hospital, Elgin, Illinois, USA
- Division of Cardiology, Department of Pediatrics, Vanderbilt Medical Center, Nashville, Tennessee, USA
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK
- Division of Cardiology, Cooper University Hospital, Camden, New Jersey, USA
- Department of Cardiology, Stony Brook Heart Institute, Stony Brook, New York, USA
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Milzi A, Dettori R, Lubberich RK, Reith S, Burgmaier K, Marx N, Burgmaier M. Quantitative Flow Ratio Is Feasible and Accurate Even at Lower Frame Acquisition Rate. Circ Cardiovasc Interv 2023; 16:e013266. [PMID: 37846560 DOI: 10.1161/circinterventions.123.013266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Andrea Milzi
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Germany (A.M., R.D., R.K.L., N.M., M.B.)
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Università Della Svizzera Italiana, Lugano, Switzerland (A.M.)
| | - Rosalia Dettori
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Germany (A.M., R.D., R.K.L., N.M., M.B.)
| | - Richard Karl Lubberich
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Germany (A.M., R.D., R.K.L., N.M., M.B.)
| | - Sebastian Reith
- Department of Cardiology, Angiology and Electrophysiology, St. Franziskus Hospital, Münster, Germany (S.R.)
| | - Kathrin Burgmaier
- Faculty of Applied Healthcare Science, Deggendorf Institute of Technology, Germany (K.B., M.B.)
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Germany (A.M., R.D., R.K.L., N.M., M.B.)
| | - Mathias Burgmaier
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Germany (A.M., R.D., R.K.L., N.M., M.B.)
- Faculty of Applied Healthcare Science, Deggendorf Institute of Technology, Germany (K.B., M.B.)
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Pedersoli F, Fang J, Boas E, Park JJ. Operator radiation exposure during radioembolisation of the liver: transfemoral versus transradial access using real-time dose monitoring. RADIATION PROTECTION DOSIMETRY 2023; 199:2344-2348. [PMID: 37644874 DOI: 10.1093/rpd/ncad236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/14/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
In this study, operator radiation exposure is compared utilising transradial access (TRA) versus transfemoral access (TFA) during transarterial radioembolisation (TARE) of liver tumors. Patients who underwent Y90 TARE between May 2017 and April 2018 were included. Electronic medical records and interventional data were collected and the following parameters evaluated: technical success, fluoroscopy time, operator radiation exposure and rate of operator radiation exposure per fluoroscopy time. Statistical analysis was performed with the Wilcoxon rank-sum test. A total of 22 patients (12 males, 10 females) underwent 22 procedures. A total of 12 procedures were performed via TFA and 10 via TRA. Technical success was 100% in both groups. Median fluoroscopy time (10 minutes for TRA vs 6.4 minutes for TFA, p = 0.082) was not statistically different. Both operator radiation exposure (49 vs 4.2 μSv, p = 0.00016) and rate of operator exposure (4.9 vs 0.71 μSv per min, p = 0.00021) were significantly higher in the TRA versus TFA groups, respectively.
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Affiliation(s)
- Federico Pedersoli
- Division of Interventional Radiology, Department of Radiology, City of Hope, Comprehensive Cancer Center, Duarte, CA 91010, United States
| | - Jieming Fang
- Division of Interventional Radiology, Department of Radiology, City of Hope, Comprehensive Cancer Center, Duarte, CA 91010, United States
| | - Edward Boas
- Division of Interventional Radiology, Department of Radiology, City of Hope, Comprehensive Cancer Center, Duarte, CA 91010, United States
| | - John J Park
- Division of Interventional Radiology, Department of Radiology, City of Hope, Comprehensive Cancer Center, Duarte, CA 91010, United States
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DiBardino DM, Kim RY, Cao Y, Andronov M, Lanfranco AR, Haas AR, Vachani A, Ma KC, Hutchinson CT. Diagnostic Yield of Cone-beam-Derived Augmented Fluoroscopy and Ultrathin Bronchoscopy Versus Conventional Navigational Bronchoscopy Techniques. J Bronchology Interv Pulmonol 2023; 30:335-345. [PMID: 35920067 PMCID: PMC10538603 DOI: 10.1097/lbr.0000000000000883] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pulmonary nodules suspicious for lung cancer are frequently diagnosed. Evaluating and optimizing the diagnostic yield of lung nodule biopsy is critical as innovation in bronchoscopy continues to progress. METHODS This is a retrospective cohort study. Consecutive patients undergoing guided bronchoscopy for suspicious pulmonary nodule(s) between February 2020 and July 2021 were included. The cone-beam computed tomography (CBCT)+ radial endobronchial ultrasound (r-EBUS) group had their procedure using CBCT-derived augmented fluoroscopy along with r-EBUS. The CBCT+ ultrathin bronchoscope (UTB)+r-EBUS group had the same procedure but with the use of an ultrathin bronchoscope. The r-EBUS group underwent r-EBUS guidance without CBCT or augmented fluoroscopy. We used multivariable logistic regression to compare diagnostic yield, adjusting for confounding variables. RESULTS A total of 116 patients were included. The median pulmonary lesion diameter was 19.5 mm (interquartile range, 15.0 to 27.5 mm), and 91 (78.4%) were in the peripheral half of the lung. Thirty patients (25.9%) underwent CBCT+UTB, 27 (23.3%) CBCT, and 59 (50.9%) r-EBUS alone with unadjusted diagnostic yields of 86.7%, 70.4%, and 42.4%, respectively ( P <0.001). The adjusted diagnostic yields were 85.0% (95% CI, 68.6% to 100%), 68.3% (95% CI, 50.1% to 86.6%), and 44.5% (95% CI, 31.0% to 58.0%), respectively. There was significantly more virtual navigational bronchoscopy use in the r-EBUS group (45.8%) compared with the CBCT+UTB (13.3%) and CBCT (18.5%) groups, respectively. CBCT procedures required dose area product radiation doses of 7602.5 µGym 2 . CONCLUSION Compared with the r-EBUS group, CBCT + UTB + r-EBUS was associated with higher navigational success, fewer nondiagnostic biopsy results, and a higher diagnostic yield. CBCT procedures are associated with a considerable radiation dose.
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Affiliation(s)
- David M. DiBardino
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Section of Interventional Pulmonology and Thoracic Oncology, Philadelphia, PA
| | - Roger Y. Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Section of Interventional Pulmonology and Thoracic Oncology, Philadelphia, PA
| | - Yulei Cao
- Drexel University College of Medicine, Philadelphia, PA
| | - Michelle Andronov
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Section of Interventional Pulmonology and Thoracic Oncology, Philadelphia, PA
| | - Anthony R. Lanfranco
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Section of Interventional Pulmonology and Thoracic Oncology, Philadelphia, PA
| | - Andrew R. Haas
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Section of Interventional Pulmonology and Thoracic Oncology, Philadelphia, PA
| | - Anil Vachani
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Section of Interventional Pulmonology and Thoracic Oncology, Philadelphia, PA
| | - Kevin C. Ma
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Section of Interventional Pulmonology and Thoracic Oncology, Philadelphia, PA
| | - Christoph T. Hutchinson
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Section of Interventional Pulmonology and Thoracic Oncology, Philadelphia, PA
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Sharma AB, Agrawal R. Reduction in Primary Operator Radiation Dose Exposure During Coronary Angioplasty Using Radiation Absorbing Drape. Cureus 2023; 15:e46619. [PMID: 37937037 PMCID: PMC10626564 DOI: 10.7759/cureus.46619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 11/09/2023] Open
Abstract
Background Percutaneous coronary intervention (PCI) involves the use of ionizing radiation and is a common procedure in a cardiac catheterization suite. The RADPAD® surgical drape (Worldwide Innovations & Technologies, Inc., Lenexa, KS) has been developed to reduce scatter radiation exposure to primary operators during routine PCI procedures. This study aims to assess the efficacy of RADPAD drapes in reducing radiation dose in the catheterization laboratory. Methods This was a single-center, prospective, observational study that aimed to compare the primary operator dose received with and without the use of a commercially available shield (RADPAD) during PCI. A total of 53 consecutive patients undergoing PCI were randomized in a 1:1 pattern to receive either the RADPAD (study group) or no RADPAD (control group). Standard shielding and personal protective equipment were used. Radiation exposure to the primary operator, total fluoroscopy time, number of cine acquisitions, and air kerma were recorded for each procedure. A one-way ANOVA calculator, including the Tukey honestly significant difference (HSD) test, was used to compare the mean values of radiation exposure. Scatterplot analysis and linear regression slopes of dose relative to air kerma were performed. All shields were reused once only. Results The study compared radiation exposure during PCI procedures between patients who received radiation attenuation devices (RADPAD) and those who did not. The RADPAD group had 30 patients, while the NO RADPAD group had 23 patients. There was a significant difference in the number of coronary angiography and single/multi-vessel PCI procedures between the two groups. There was no significant difference in procedural time or air kerma dose between the groups, but the RADPAD group had a significantly lower radiation dose (mean dose of 3.679 mrem) compared to the NO RADPAD group (mean dose of 8.12 mrem) (p < 0.00001). The primary operator dose per unit of air kerma was also significantly lower in the RADPAD group. Overall, the use of RADPAD resulted in a significant reduction in radiation exposure during PCI procedures. Conclusion The present study provides further evidence for the efficacy of using radiation-absorbing drapes (RADPAD) in reducing primary operator radiation dose exposure during coronary angioplasty. The equipment for radiation dose reduction of patients also reduces the radiation dose of medical staff. Therefore, the use of RADPAD is recommended as a safe and effective measure for reducing operator radiation dose exposure during coronary angioplasty.
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Roguin A, Wu P, Cohoon T, Gul F, Nasr G, Premyodhin N, Kern MJ. Update on Radiation Safety in the Cath Lab - Moving Toward a "Lead-Free" Environment. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101040. [PMID: 39131633 PMCID: PMC11307637 DOI: 10.1016/j.jscai.2023.101040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 08/13/2024]
Abstract
Radiation exposure in the cardiac catheterization laboratory (CCL) is an occupational hazard that predisposes health care workers to the development of adverse health effects such as cataracts, cancer, and orthopedic injury. To mitigate radiation exposure, personal protective shielding as well as permanently installed shields reduces these adverse effects. Yet, heavy protective lead aprons and poor ergonomics required for positioning movable shields remain barriers to a safer environment. Recent innovations to enhance personal protective equipment and revolutionize fixed shielding systems will permit the CCL team to work in a personal "lead-free" environment, markedly reducing occupational hazards. The purpose of this review is to update the status and future of radiation protection in the CCL.
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Affiliation(s)
- Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
- Faculty of Medicine, Technion - Israel Institute of Technology, Israel
| | - Perry Wu
- Division of Cardiology, University of California – Irvine, Irvine, California
- VA Long Beach, Long Beach, California
| | - Travis Cohoon
- Division of Cardiology, University of California – Irvine, Irvine, California
- VA Long Beach, Long Beach, California
| | - Fahad Gul
- Division of Cardiology, University of California – Irvine, Irvine, California
- VA Long Beach, Long Beach, California
| | - George Nasr
- Division of Cardiology, University of California – Irvine, Irvine, California
- VA Long Beach, Long Beach, California
| | - Ned Premyodhin
- Division of Cardiology, University of California – Irvine, Irvine, California
- VA Long Beach, Long Beach, California
| | - Morton J. Kern
- Division of Cardiology, University of California – Irvine, Irvine, California
- VA Long Beach, Long Beach, California
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Rizik DG, Riley RD, Burke RF, Klassen SR, Nigoghosian AM, Gosselin KP, Goldstein JA. Comprehensive Radiation Shield Minimizes Operator Radiation Exposure and Obviates Need for Lead Aprons. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100603. [PMID: 39130703 PMCID: PMC11307751 DOI: 10.1016/j.jscai.2023.100603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 08/13/2024]
Abstract
Background The catheterization laboratory predisposes to occupational health hazards. Chronic radiation exposure (RE) direct injuries include a predilection to cataracts and concerns for cancers. Indirectly adverse effects underly the prevalence of orthopedic maladies in interventionists, linked to the burden of mandatory protective lead aprons. A novel comprehensive shielding system (Protego, Image Diagnostics Inc) has been validated in early studies to provide excellent radiation protection. The system is designed to reduce operator RE sufficient to eliminate the need for personal lead aprons. Recent system refinements offer potentially even greater degrees of protection. This clinical study evaluated the efficacy of this system. Methods This single-center 2-group cohort study compared physician operator RE utilizing the latest iteration of the Protego shield (n = 25 cases) or standard protection (personal leaded apparel and drop-down shield, n = 25 cases) during routine cardiac catheterization procedures. RE at both thyroid and waist levels were measured with a real-time dosimetry system (Raysafe) and calculated on a mean per case basis at both thyroid and waist levels. Additional parameters collected included procedure type, access site, per case fluoroscopy time, and patient factors including body mass index. Between-group comparisons were conducted to evaluate RE by group and measurement sites. Results Protection with Protego was superior to standard methods. Protego showed markedly lower RE at both the thyroid level (0.36 ± 0.86 vs 58.5 ± 50.2 μSv; P < .001) and the waist level (0.84 ± 2.99 vs 121.4 ± 171.2 μSv; P < .001. "Zero" total RE was documented in 68% (n = 17) of Protego cases; in contrast, standard protection did not achieve "zero" exposure in a single case. Conclusions The Protego shield system provides excellent RE protection to the physician operator, achieving "zero" RE in two-thirds of cases. RE was superior to standard protection methods. The magnitude of protection achieves state regulatory standards sufficient to allow operators to perform procedures without orthopedically burdensome lead aprons. This shield system has the potential to reduce occupational health hazards.
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Affiliation(s)
- David G. Rizik
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
| | - Robert D. Riley
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
| | - Robert F. Burke
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
| | - Sabrina R. Klassen
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
| | | | - Kevin P. Gosselin
- Department of Cardiovascular Medicine, Honor Health, Scottsdale, Arizona
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de Oliveira Cardoso C, de Moraes CV, Teixeira JV, Cardoso CR, Baldissera F, de Mattos EI, Siqueira MJ, Fischer L, Sebben JC, Santos Silva B, Broetto G, Antônio Mascia Gottschall C, Sarmento-Leite R. Randomized Noninferiority Trial of Radiation Exposure During Coronary Angiography: the Transradial and Transfemoral Approach by EXPERienced Operators in Daily rouTine (EXPERT) Trial. Tex Heart Inst J 2023; 50:491654. [PMID: 36944120 PMCID: PMC10178642 DOI: 10.14503/thij-22-7930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND The transradial approach (TRA) to coronary angiography reduces vascular complications but is associated with greater radiation exposure than the transfemoral approach (TFA). It is unknown whether exposure remains higher when TRA is performed by experienced operators. METHODS Patients were randomly, prospectively assigned to TRA or TFA. The primary end point was patient radiation dose; secondary end points were the physician radiation dose and 30-day major adverse cardiac event rate. Coronary angiography was performed by experienced operators using a standardized protocol. RESULTS Clinical and procedural characteristics were similar between the TRA (n = 150) and TFA (n = 149) groups, and they had comparable mean (SD) radiation doses for patients (616.51 [252] vs 585.57 [225] mGy; P = .13) and physicians (0.49 [0.3] vs 0.46 [0.29] mSv; P = .32). The mean (SD) fluoroscopy time (3.52 [2.02] vs 3.13 [2.46] min; P = .14) and the mean (SD) dose area product (35,496.5 [15,670] vs 38,313.4 [17,764.9] mGy·cm2; P = .2) did not differ. None of the following factors predicted higher radiation doses: female sex (hazard ratio [HR], 0.69 [95% CI, 0.38-1.3]; P = .34), body mass index >25 (HR, 0.84 [95% CI, 0.43-1.6]; P = .76), age >65 years (HR, 1.67 [95% CI, 0.89-3.1]; P = .11), severe valve disease (HR, 1.37 [95% CI, 0.52-3.5]; P = .68), or previous coronary artery bypass graft (HR, 0.6; 95% CI, 0.2-1.8; P = .38). CONCLUSION TRA for elective coronary angiography is noninferior to TFA when performed by experienced operators.
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Affiliation(s)
- Cristiano de Oliveira Cardoso
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Health Sciences (Cardiology - PPG), University Foundation of Cardiology, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cláudio Vasques de Moraes
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Julio Vinícius Teixeira
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlos Roberto Cardoso
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Felipe Baldissera
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eduardo Ilha de Mattos
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcio José Siqueira
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Leandro Fischer
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Juliana Cañedo Sebben
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bruna Santos Silva
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gabriel Broetto
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlos Antônio Mascia Gottschall
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Health Sciences (Cardiology - PPG), University Foundation of Cardiology, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rogério Sarmento-Leite
- Cardiology Institute, Rio Grande do Sul/University Foundation of Cardiology (IC-FUC), Department of Invasive Cardiology and Hemodynamics, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Health Sciences (Cardiology - PPG), University Foundation of Cardiology, Porto Alegre, Rio Grande do Sul, Brazil
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You K, Guo T, Sun D, Song H, Liu Z. Transradial versus transfemoral approach for TACE: a retrospective study. BMC Gastroenterol 2023; 23:11. [PMID: 36631744 PMCID: PMC9835221 DOI: 10.1186/s12876-023-02646-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Transcatheter arterial chemoembolization (TACE) has been widely applied in the treatment of hepatocellular carcinoma (HCC). Our study aimed to investigate the feasibility and efficacy of transradial access as an alternative to transfemoral access for TACE. METHODS Patients undergoing TACE were divided into the radial artery (RA) route group or the femoral artery (FA) route group according to the operation approach, namely, transradial or transfemoral access. We retrospectively analysed the clinical characteristics, technical outcomes, clinical efficacy and incidence of adverse events to compare the two technologies for intervention for HCC. RESULTS Transradial access was found to achieve superior technical outcomes and clinical efficacy, as the patients in the RA group had a lower rate of hepatic arterial spasm, a higher partial response rate and a lower progression rate than the patients in the FA group according to the mRECIST evaluations. In contrast, the liver function indices and VAS (visual analogue scale) pain scores were consistent across the two groups. Moreover, patients in the RA group had a shorter length of stay than those in the FA group, despite similar hospitalization expenses. The total adverse events were significantly reduced by transradial access for TACE (72.5% vs. 84.1%, P = 0.027). CONCLUSION Our study suggested that transradial access is an effective and feasible alternative to transfemoral access for TACE. Large-scale prospective randomized controlled studies are expected.
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Affiliation(s)
- Ke You
- grid.412461.40000 0004 9334 6536Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Linjiang Road 74, Chongqing, 400010 China
| | - Tao Guo
- grid.477425.7Liuzhou Key Laboratory of Infection Disease and ImmunologyGuangxi Health Commission Key Laboratory of Clinical Biotechnology, Liuzhou People’s Hospital affiliated to Guangxi Medical University, Liuzhou, 545006 China ,grid.268079.20000 0004 1790 6079Department of Pathophysiology, School of Basic Medical Sciences, Weifang Medical University, Weifang, 261053 China
| | - Da Sun
- Department of Organ Transplantation, Third Affiliated Hospital of Naval Military Medical University, North Moyu Road 700, Shanghai, 201805 China
| | - Hao Song
- Department of Organ Transplantation, Third Affiliated Hospital of Naval Military Medical University, North Moyu Road 700, Shanghai, 201805 China
| | - Zuojin Liu
- grid.412461.40000 0004 9334 6536Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Linjiang Road 74, Chongqing, 400010 China
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11
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Saqib N, Pir MS, Rajagopalan S, Patel TM, Pancholy SB. Comparison of radiation exposure associated with transradial and transfemoral access: An updated meta-analysis. Catheter Cardiovasc Interv 2023; 101:87-96. [PMID: 36490230 DOI: 10.1002/ccd.30513] [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: 03/04/2022] [Revised: 11/01/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess differences in radiation exposure between transradial access (TRA) and transfemoral access (TFA) for coronary procedures. BACKGROUND TRA is associated with increased radiation exposure as compared to TFA. We compared radiation exposure between the two access sites. METHODS Databases were searched from June 2014 to August 2021 for randomized controlled trials (RCTs) reporting coprimary outcomes of fluoroscopy time (FT) and/or dose area product (DAP) comparing TRA with TFA. Meta-regression was performed to assess the behavior of weighted mean difference (WMD) in FT from 1995 to 2021. Observational study data was used for corroborative evidence. RESULTS Data from 8 RCTs (11,611 patients) showed the WMD of FT was 0.62 min (37 s) (95% confidence interval [CI]: [0.08-1.17], p = 0.023) in favor of TFA, WMD in DAP (9169 patients) was 1.94 Gy.cm2 (95% CI: [-2.1 to 5.9], p = 0.35) showing no significant difference. Pooled data from OBS and RCTs (83,990 patients) showed a similar trend. Studies from outside US between 1995 and 2021 showed WMD of FT between TRA and TFA of 0.88 min (52 s) (95% CI: [0.67-1.09], p = 0.005) versus 2.1 min (126 s) (95% CI: [1.38-2.8], p = 0.005) for US in favor of TFA. Meta-regression showed a declining WMD of FT between TRA and TFA from 1.6 min (96 s) in 1996 to 0.5 min (30 s) in 2020 with the lower limit of CI crossing the zero line in 2019. CONCLUSION Radiation exposure between TRA and TFA continues to decrease overtime and is becoming clinically nonsignificant.
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Affiliation(s)
- Najam Saqib
- The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | - Muhammad S Pir
- The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | - Sharath Rajagopalan
- The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | | | - Samir B Pancholy
- The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
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12
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Ford TJ, Bamford P, Barlis P, Said C. Radial Artery, Alternative Arm Access, and Related Techniques. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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13
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Goel S, Casazza R, Pasam RT, Montagna E, Gotesman J, Frankel R, Borgen E, Crooke G, Saunders P, Shani J. Operator Radiation Exposure During Transfemoral Transcatheter Aortic Valve Replacement. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100002. [PMID: 37273470 PMCID: PMC10236896 DOI: 10.1016/j.shj.2022.100002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 08/10/2021] [Accepted: 09/29/2021] [Indexed: 06/06/2023]
Abstract
Background The level of radiation exposure received by operators performing transcatheter aortic valve replacement (TAVR) is not well investigated. The aim of this study is to measure the amount of radiation received by operators performing transfemoral TAVR and to identify various patient and procedural characteristics associated with increased radiation exposure. Methods Primary (operator 1) and secondary (operator 2) operators' equivalent radiation doses in micro Sieverts (µSv) were calculated prospectively using real-time radiation dosimeters for a total of 140 consecutive transfemoral TAVRs. Corresponding eye and thorax radiation exposures between the operators were compared. Associations between various patient and procedural characteristics and the radiation exposure were tested using the t-test and Wilcoxon Mann-Whitney rank-sum test with Monte Carlo estimation. Multivariable regression analysis was also conducted. Results Operator 1 had significantly higher cumulative equivalent radiation exposure than operator 2 (86 µSv vs 38 µSv, p-value: <0.0001) which was consistent at the level of the thorax (67 µSv vs 22 µSv, p-value: <0.0001), but not at the level of the eye (16.5 µSv vs 15 µSv, p-value: 0.30). On multivariable analysis, patient obesity and intraprocedural complications were associated with higher radiation exposure to both operators. Ad hoc percutaneous coronary intervention led to excessive radiation exposure to the secondary operator. Conclusions Transfemoral TAVR is associated with a modest amount of radiation exposure to operators and is significantly higher for the primary operator than for the secondary operator.
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Affiliation(s)
- Sunny Goel
- Department of Cardiology, Mount Sinai Medical Center, New York, New York, USA
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Richard Casazza
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Ravi Teja Pasam
- Department of Internal Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Enrico Montagna
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Joseph Gotesman
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Robert Frankel
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Elliot Borgen
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Gregory Crooke
- Department of Cardiothoracic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Paul Saunders
- Department of Cardiothoracic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Jacob Shani
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
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14
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Distal or Traditional Transradial Access Site for Coronary Procedures: A Single-Center, Randomized Study. JACC Cardiovasc Interv 2021; 15:22-32. [PMID: 34922888 DOI: 10.1016/j.jcin.2021.09.037] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVES This study aimed to compare the efficacy and safety of the distal transradial approach (dTRA) versus the conventional transradial approach (TRA) for coronary angiography and percutaneous coronary interventions. BACKGROUND The recommended approach for coronary procedures is TRA. However, it is associated with radial artery occlusion (RAO). The dTRA could potentially decrease the incidence of RAO. METHODS One thousand forty-two consecutive patients were randomized (1:1) to right dTRA or TRA. The primary endpoint was the rate of RAO, which was evaluated by Doppler ultrasound at 60 days after randomization. RESULTS Five hundred eighteen and 524 patients were randomized to dTRA and TRA, respectively. Follow-up Doppler evaluation of the radial artery was accomplished in 404 (78.0%) patients in the dTRA group and 392 (74.8%) in the TRA group. The rate of RAO was significantly reduced in the dTRA group compared with TRA group (3.7% vs 7.9%, respectively; P = 0.014). The rate of successful sheath insertion was lower in the dTRA group compared with the TRA group (78.7% vs 94.8%, respectively; P < 0.001). More punctures (median = 2 [IQR: 1-3] vs median = 1 [IQR: 1-2]; P < 0.001) and a longer time (120 vs 75 seconds; P < 0.001) were required for sheath insertion in the dTRA group compared with the TRA group. The hemostasis time was shorter in the dTRA group compared with the TRA group (60 vs 120 minutes; P < 0.001). The dose area product was higher in the dTRA group (median = 32,729 in the dTRA vs 28,909 cGy/cm2 in the TRA group; P = 0.02). No significant differences were observed in the secondary safety endpoints (bleeding [Bleeding Academic Research Consortium ≥ 2] and severe radial artery spasm). CONCLUSIONS According to our study, dTRA was associated with a lower rate of forearm RAO, a shorter time of hemostasis, a higher crossover rate and dose area product, and a longer procedural time compared with TRA.
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15
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Wilson-Stewart KS, Fontanarosa D, Malacova E, Trapp JV. Radiation dose to nurses, cardiologists, and patients during coronary angiography: a comparison of femoral and radial access. Eur J Cardiovasc Nurs 2021; 21:325-331. [PMID: 34718509 DOI: 10.1093/eurjcn/zvab096] [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: 05/20/2021] [Revised: 08/26/2021] [Accepted: 10/03/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Exposure to radiation during fluoroscopically guided cardiac procedures is a cause for concern for both the patient and staff. AIMS This study sought to compare the occupational and patient radiation dose during femoral and radially accessed invasive coronary angiography (CA). METHODS AND RESULTS Occupational dose (µSv) was measured at the left temple of the cardiologist (n = 17), scrub (n = 27), and circulator nurse (n = 27) during 761 femoral and 671 radially accessed diagnostic coronary angiograms and percutaneous coronary intervention (PCI) procedures. Patient dose parameters of dose area product (DAP) (Gy.cm2) and air kerma (AK) (Gy) were also measured. Coronary angiography performed via the radial artery is associated with greater mean dose to the cardiologist, with the exception of procedures including only PCI. Results demonstrated that scrub nurses are exposed to higher mean doses than the cardiologist when using femoral access and similar doses during radial cases. Both AK and DAP were associated with a higher average dose for femoral PCI than radial, with DAP being significantly higher. CONCLUSIONS Awareness of factors that increase the dose to staff and patients is vital to inform and improve practice. This study has demonstrated that access route during diagnostic CA and PCI influences both patient and staff dose. Radiation dose to in-room staff other than the fluoroscopic operator should be a focus of future research. In addition, all staff present during X-ray guided procedures should be provided with radiation education and adopt dose minimization strategies to reduce occupational exposures.
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Affiliation(s)
- Kelly S Wilson-Stewart
- School of Chemistry and Physics, Faulty of Science and Engineering, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia.,Greenslopes Private Hospital, Ramsay Health Care, Newdegate Street, Greenslopes, Brisbane, QLD 4120 Australia
| | - Davide Fontanarosa
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia.,Centre for Biomedical Technologies (CBT), Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia
| | - Eva Malacova
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia.,QMIR Berghofer Medical Research Institute, 200 Herston Road, Herston, QLD 4006 Australia
| | - Jamie V Trapp
- School of Chemistry and Physics, Faulty of Science and Engineering, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000 Australia
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16
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Fernandez R, Ellwood L, Barrett D, Weaver J. Safety and effectiveness of strategies to reduce radiation exposure to proceduralists performing cardiac catheterization procedures: a systematic review. JBI Evid Synth 2021; 19:4-33. [PMID: 32868713 DOI: 10.11124/jbisrir-d-19-00343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this systematic review was to synthesize the best available evidence on the effect of various radiation protection strategies on radiation dose received by proceduralists performing cardiac catheterization procedures involving fluoroscopy. INTRODUCTION Cardiac catheterization procedures under fluoroscopy are the gold standard diagnostic and treatment method for patients with coronary artery disease. The growing demand of procedures means that proceduralists are being exposed to increasing amounts of radiation, resulting in an increased risk of deterministic and stochastic effects. Standard protective strategies and equipment such as lead garments reduce radiation exposure; however, the evidence surrounding additional equipment is contradictory. INCLUSION CRITERIA Randomized controlled trials that compared the use of an additional radiation protection strategy with conventional radiation protection methods were considered for inclusion. The primary outcome of interest was the radiation dose received by the proceduralist during cardiac catheterization procedures. METHODS A three-step search was conducted in MEDLINE, CINAHL, Embase, and the Cochrane Library (CENTRAL). Trials published in the English language with adult participants were included. Trials published from database inception until July 2019 were eligible for inclusion. The methodological quality of the included studies was assessed using the JBI critical appraisal checklist for randomized controlled trials. Quantitative data were extracted from the included papers using the JBI data extraction tool. Results that could not be pooled in meta-analysis were reported in a narrative form. RESULTS Fifteen randomized controlled trials were included in the review. Six radiation protection strategies were assessed: leaded and unleaded pelvic or arm drapes, transradial protection board, remotely controlled mechanical contrast injector, extension tubing for contrast injection, real-time radiation monitor, and a reduction in frame rate to 7.5 frames per second. Pooled data from two trials demonstrated a statistically significant decrease in the mean radiation dose (P < 0.00001) received by proceduralists performing transfemoral cardiac catheterization on patients who received a leaded pelvic drape compared to standard protection. One trial that compared the use of unleaded pelvic drapes placed on patients compared to standard protection reported a statistically significant decrease (P = 0.004) in the mean radiation dose received by proceduralists.Compared to standard protection, two trials that used unleaded arm drapes for patients, one trial that used a remotely controlled mechanical contrast injector, and one trial that used a transradial protection board demonstrated a statistically significant reduction in the radiation dose received by proceduralists.Similarly, using a frame rate of 7.5 versus 15 frames per second and monitoring radiation dose in real-time radiation significantly lowered the radiation dose received by the proceduralist. One trial demonstrated no statistically significant difference in proceduralist radiation dose among those who used the extension tubing compared to standard protection (P = 1). CONCLUSIONS This review provides evidence to support the use of leaded pelvic drapes for patients as an additional radiation protection strategy for proceduralists performing transradial or transfemoral cardiac catheterization. Further studies on the effectiveness of using a lower fluoroscopy frame rate, real-time radiation monitor, and transradial protection board are needed.
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Affiliation(s)
- Ritin Fernandez
- Centre for Evidence Based Initiatives in Health Care: A JBI Centre of Excellence, Wollongong, NSW, Australia.,Centre for Research in Nursing and Health, St George Hospital, Sydney, NSW, Australia.,School of Nursing, University of Wollongong, Sydney, NSW, Australia
| | - Laura Ellwood
- Centre for Evidence Based Initiatives in Health Care: A JBI Centre of Excellence, Wollongong, NSW, Australia.,Centre for Research in Nursing and Health, St George Hospital, Sydney, NSW, Australia
| | - David Barrett
- Interventional Cardiology, St Andrews Private Hospital, Ipswich, QLD, Australia
| | - James Weaver
- Cardiology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, NSW, Australia
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17
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Lodha A, Giannopoulos S, Sumar R, Ratcliffe J, Gorenchtein M, Green P, Rollefson W, Stout CL, Armstrong EJ. Transradial endovascular intervention: Results from the Radial accEss for nAvigation to your CHosen lesion for Peripheral Vascular Intervention (REACH PVI) study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:115-120. [PMID: 34020900 DOI: 10.1016/j.carrev.2021.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/04/2021] [Accepted: 05/13/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND/PURPOSE The transradial approach has been proposed as an alternative to traditional transfemoral access for diagnostic and therapeutic purposes in several catheterization procedures. Historically, extended length devices for lower limb endovascular interventions have been limited. The aim of this study was to investigate the acute clinical outcomes of orbital atherectomy (OA) via transradial access (TRA) for the treatment of lower extremity peripheral artery disease (PAD). METHODS/MATERIALS REACH PVI was a multicenter, prospective, observational study (NCT03943160) including subjects with PAD and target lesion morphology appropriate for OA. All patients were followed post-procedure through the first standard of care follow-up visit. RESULTS A total of 50 patients were enrolled. In most cases the indication for intervention was disabling claudication (74.0%). Overall, 50 target lesions were treated, 92.0% of lesions were femoropopliteal and 8.0% were infrapopliteal. The average lesion length was 98.3 ± 87.5 mm and 78.0% of the lesions were severely calcified. Balloon angioplasty was performed in 98.0% of target lesions, while a stent was deployed in 16.0%. Treatment success was 98.0%; in only one case the result was sub-optimal (>30% stenosis with stent placement) and a significant dissection was reported. No serious distal embolization, serious thrombus formation or serious acute vessel closure were observed intra- or post-procedurally. CONCLUSIONS Transradial OA followed by percutaneous transluminal angioplasty for lower extremity PAD is feasible and demonstrates a favorable safety profile. Extended length devices such as the Extended Length Orbital Atherectomy System could further facilitate transradial endovascular procedures by increasing its spectrum of application.
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Affiliation(s)
- Ankur Lodha
- Cardiovascular Institute of the South - Lafayette, Lafayette, LA, United States
| | - Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, United States
| | - Riyaz Sumar
- Arizona Cardiovascular Research Center, Phoenix, AZ, United States
| | | | | | | | | | | | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, United States.
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18
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Nagaraja V, Rao SV, George S, Mamas M, Nolan J. Evidence-based arterial access site practice in patients with acute coronary syndromes: Has SAFARI-STEMI changed the landscape? Catheter Cardiovasc Interv 2021; 97:1417-1421. [PMID: 33837993 DOI: 10.1002/ccd.29684] [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: 12/08/2020] [Revised: 02/18/2021] [Accepted: 03/14/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Vinayak Nagaraja
- Keele Cardiovascular Research Group, Center for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK.,Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK.,Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Mamas Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK.,Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - James Nolan
- Keele Cardiovascular Research Group, Center for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Keele, UK.,Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
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19
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Gupta A, Chhikara S, Vijayvergiya R, Barwad P, Prasad K, Datta R, Mahesh NK, Maurya P, Singh N. Radiation Exposure Reduction and Patient Outcome by Using Very Low Frame Rate Fluoroscopy Protocol (3.8 + 7.5 fps) During Percutaneous Coronary Intervention. Front Cardiovasc Med 2021; 8:625873. [PMID: 33634171 PMCID: PMC7900165 DOI: 10.3389/fcvm.2021.625873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/18/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives: In this study, we intend to analyze the feasibility and efficacy of very low frame rate fluoroscopy (VLFF) protocol using a combination of 3.8 and 7.5 fps while performing Percutaneous Coronary Intervention (PCI). Methods: A retrospective cohort including 193 patients undergoing PCI under the VLFF protocol (Post-VLFF group) was compared with a retrospective cohort of 133 patients, who underwent PCI prior to implementation of VLFF protocol (Pre-VLFF group). In the Pre-VLFF group, all PCIs were performed using fluoroscopy frame rate of 15 fps. In the Post-VLFF group, 3.8 fps was used to guide catheter engagement, coronary lesion wiring, pre-and post-dilation, and 7.5 fps was used for lesion assessment and stent placement. Increasing use of fluoroscopic storage in place of cineangiography was also encouraged. Cine acquisition in both groups was performed at 15 fps. Primary endpoint was radiation exposure measured by Air Kerma. Secondary endpoints were procedure related outcomes and patient related outcomes (Major Adverse Cardiac Events including all-cause mortality, Target Lesion Failure, Myocardial Infarction, and Stroke). RESULTS: Post-VLFF group showed 74.7% reduction in Air Kerma as compared to Pre-VLFF group (433 ± 27 mGy vs. 1,714 ± 140 mGy; p < 0.0001), with no increase in the fluoroscopy time (15.38 ± 0.98 min Post-VLFF vs. 17.06 ± 1.29 min Pre-VLFF; p = 0.529) and contrast volume (116.5 ± 4.9 ml Post-VLFF vs. 116.7 ± 6 ml Pre-VLFF; p = 0.700). Both groups had comparable procedural success and complications rates as well as incidence of MACE. Conclusions: The very low frame rate fluoroscopy protocol is a feasible, effective, and safe method to significantly reduce the radiation exposure during PCI without any compromise on procedural and patient outcomes.
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Affiliation(s)
- Ankush Gupta
- Department of Cardiology, Military Hospital Jaipur, Jaipur, India
| | - Sanya Chhikara
- Vardhman Mahavir Medical College, & Safdarjung Hospital, New Delhi, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, India
| | - Parag Barwad
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, India
| | - Krishna Prasad
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, India
| | - Rajat Datta
- Department of Cardiology, Army Hospital Research & Referral, New Delhi, India
| | - Nalin K Mahesh
- Department of Cardiology, Apollo Adlux Hospital, Kochi, India
| | | | - Navreet Singh
- Department of Cardiology, The Air Force Central Medical Establishment, New Delhi, India
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20
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Bellamoli M, Venturi G, Pighi M, Pacchioni A. Transradial artery access for percutaneous cardiovascular procedures: state of the art and future directions. Minerva Cardiol Angiol 2020; 69:557-578. [PMID: 33146480 DOI: 10.23736/s2724-5683.20.05391-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The transradial access (TRA) for cardiac catheterization and percutaneous coronary intervention (PCI) has been widely adopted in the last decades since its first description in the late 40s. The transradial approach has been associated with favorable outcomes as compared with transfemoral access (TFA) in several registries and randomized clinical trials, mainly due to the lower incidence of access-site bleedings, vascular complications and improved patient comfort. This review aimed to summarize the body of evidence supporting the use of TRA, to discuss clinical implications, possible technical limitations and future directions, such as the implementation of TRA as the primary access for complex procedures and structural interventions.
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Affiliation(s)
- Michele Bellamoli
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Gabriele Venturi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Pacchioni
- Department of Cardiology, Civil Hospital, Mirano, Venice, Italy -
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21
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McCutcheon K, Vanhaverbeke M, Pauwels R, Dabin J, Schoonjans W, Bennett J, Adriaenssens T, Dubois C, Sinnaeve P, Desmet W. Efficacy of MAVIG X-Ray Protective Drapes in Reducing Operator Radiation Dose in the Cardiac Catheterization Laboratory: A Randomized Controlled Trial. Circ Cardiovasc Interv 2020; 13:e009627. [PMID: 33092401 DOI: 10.1161/circinterventions.120.009627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Interventional cardiologists are occupationally exposed to high doses of ionizing radiation. The MAVIG X-ray protective drape (MXPD) is a commercially available light weight, lead-free shield placed over the pelvic area of patients to minimize operator radiation dose. The aim of this study was to examine the efficacy of the MXPD during routine cardiac catheterization, including percutaneous coronary interventions. METHODS We performed a prospective, randomized controlled study comparing operator radiation dose during cardiac catheterization and percutaneous coronary intervention (n=632) with or without pelvic MXPD. We measured operator radiation dose at 4 sites: left eye, chest, left ring finger, and right ring finger. The primary outcomes were the difference in first operator radiation dose (µSv) and relative dose of the first operator (radiation dose normalized for dose area product) at the level of the chest in the 2 groups. RESULTS The use of the MXPD was associated with a 50% reduction in operator radiation dose (median dose 30.5 [interquartile range, 23.0-39.7] µSv in no drape group versus 15.3 [interquartile range, 11.1-20.0] µSv in the drape group; P<0.001) and a 57% reduction in relative operator dose (P<0.001). The largest absolute reduction in dose was observed at the left finger (median left finger dose for the no drape group was 104.9 [75.7-137.4] µSv versus 41.9 [32.6-70.6] µSv in the drape group; P<0.001). CONCLUSIONS The pelvic MXPD significantly reduces first operator radiation dose during routine cardiac catheterization and percutaneous coronary intervention. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT04285944.
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Affiliation(s)
- Keir McCutcheon
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Maarten Vanhaverbeke
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium (J.D., W.S.)
| | - Ruben Pauwels
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.)
| | - Jérémie Dabin
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium (J.D., W.S.)
| | - Werner Schoonjans
- Belgian Nuclear Research Centre, Research in Dosimetric Applications, Mol, Belgium (J.D., W.S.)
| | - Johan Bennett
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Tom Adriaenssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Christophe Dubois
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Peter Sinnaeve
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
| | - Walter Desmet
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium (K.M., M.V., R.P., J.B., T.A., C.D., P.S., W.D.).,Department of Cardiovascular Sciences, Katholieke Universiteit, Leuven, Belgium (K.M., J.B., T.A., C.D., P.S., W.D.)
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22
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Leistner DM, Schlender LS, Steiner J, Erbay A, Klotsche J, Schauerte P, Haghikia A, Rauch-Kröhnert U, Sinning D, Lauten A, Mochmann HC, Skurk C, Landmesser U, Stähli BE. A randomised comparison of monoplane versus biplane fluoroscopy in patients undergoing percutaneous coronary intervention: the RAMBO trial. EUROINTERVENTION 2020; 16:672-679. [PMID: 32392169 DOI: 10.4244/eij-d-20-00217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Interventional cardiologists are exposed to substantial occupational ionising radiation. This study sought to investigate differences in radiation exposure in biplane versus monoplane coronary angiography and percutaneous coronary interventions (PCI). METHODS AND RESULTS RAMBO (RAdiation exposure in Monoplane versus Biplane cOronary angiography and interventions) was a prospective, randomised, two-arm, single-centre, open-label trial, enrolling a total of 430 patients undergoing coronary angiography. Patients were randomly assigned to biplane or monoplane imaging. The primary efficacy measure, the operator radiation dose at the level of the left arm as measured by a wearable electronic dosimeter, was significantly higher in the biplane as compared to the monoplane group (4 [1-13] µSv vs 2 [0-6.8] µSv, p<0.001). The dose area product was 11,955 (7,095-18,246) mGy*cm2 and 8,349 (5,851-14,159) mGy*cm2 in the biplane and the monoplane groups, respectively (p<0.001). While fluoroscopy time did not differ between the groups (p=0.89), the amount of contrast medium was lower with biplane as compared with monoplane imaging (p<0.001). CONCLUSIONS Biplane imaging for coronary angiography and PCI is related to an increased radiation exposure for the interventional cardiologist as compared with monoplane imaging. Monoplane imaging should be considered for advanced radioprotection in cardiac catheterisation, with biplane imaging used for selected cases only.
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Affiliation(s)
- David M Leistner
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, and DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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23
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Buytaert D, Drieghe B, Van Heuverswyn F, De Pooter J, Gheeraert P, De Wolf D, Taeymans Y, Bacher K. Combining Optimized Image Processing With Dual Axis Rotational Angiography: Toward Low-Dose Invasive Coronary Angiography. J Am Heart Assoc 2020; 9:e014683. [PMID: 32605408 PMCID: PMC7670532 DOI: 10.1161/jaha.119.014683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Dual axis rotational coronary angiography (DARCA) reduces radiation exposure during coronary angiography on older x‐ray systems. The purpose of the current study is to quantify patient and staff radiation exposure using DARCA on a modality already equipped with dose‐reducing technology. Additionally, we assessed applicability of 1 dose area product to effective dose conversion factor for both DARCA and conventional coronary angiography (CCA) procedures. Methods and Results Twenty patients were examined using DARCA and were compared with 20 age‐, sex‐, and body mass index–matched patients selected from a prior study using CCA on the same x‐ray modality. All irradiation events are simulated using PCXMC (STUK, Finland) to determine organ and effective doses. Moreover, for DARCA each frame is simulated. Staff dose is measured using active personal dosimeters (DoseAware, Philips Healthcare, The Netherlands). With DARCA, median cumulative dose area product is reduced by 57% (ie, 7.41 versus 17.19 Gy·cm2). Effective dose conversion factors of CCA and DARCA are slightly different, yet this difference is not statistically significant. The occupational dose at physician's chest, leg, and collar level are reduced by 60%, 56%, and 16%, respectively, of which the first 2 reached statistical significance. Median effective dose is reduced from 4.75 mSv in CCA to 2.22 mSv in DARCA procedures, where the latter is further reduced to 1.79 mSv when excluding ventriculography. Conclusions During invasive coronary angiography, DARCA reduces radiation exposure even further toward low‐dose values on a system already equipped with advanced image processing and noise reduction algorithms. For both DARCA and CCA procedures, using 1 effective dose conversion factor of 0.30 mSv·Gy−1·cm−2 is feasible.
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Affiliation(s)
- Dimitri Buytaert
- Department of Human Structure and Repair Ghent University Ghent Belgium
| | - Benny Drieghe
- Heart Center Ghent University Hospital Ghent Belgium
| | | | - Jan De Pooter
- Heart Center Ghent University Hospital Ghent Belgium
| | | | - Daniël De Wolf
- Department of Paediatric Cardiology Ghent University Hospital Ghent Belgium
| | - Yves Taeymans
- Heart Center Ghent University Hospital Ghent Belgium
| | - Klaus Bacher
- Department of Human Structure and Repair Ghent University Ghent Belgium
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24
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Sezavar SH, Hassanzadeh M, Akhlagh Moayed D, Tabandeh M, Ghasemi M, Abdi S, Firoozi I, Golbidi P, Pourjafari M, Taslimi N, Akhlaghi AA, Hashemian M. Current practice of percutaneous coronary intervention on patients with acute coronary syndrome in Iran: A prospective observational study. Med J Islam Repub Iran 2020; 34:13. [PMID: 32551302 PMCID: PMC7293802 DOI: 10.34171/mjiri.34.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Frequent Percutaneous Coronary Intervention (PCI) procedures are being performed on a daily basis in Iran. However, no study has been reported on the current PCI practice in patients with acute coronary syndrome (ACS) in Iran. We aimed to describe the clinical characteristics and treatment patterns in Iranian ACS patients treated with PCI.
Methods: Between February 2017 and July 2017, ACS patients presented to 5 referral hospitals in two major cities of Iran (Tehran and Shiraz) were included in this observational study if aged > 18 years and underwent PCI for ACS during hospitalization; and their clinical and procedural characteristics were collected. All data were entered into SPSS v.21 and descriptive statistics were performed.
Results: Of a total of 314 patients, 228 (73%) were males, 162 (52%) were diagnosed with ST-elevation myocardial infarction and 152 (48%) with Unstable angina/ Non-ST elevation myocardial infarction. Trans-femoral approach was more often (64%) used for PCI procedures. Stent placement was the most frequent (98%) treatment strategy on PCI, with drug-eluting stent selected in the majority of subjects (98%). The overall rate of PCI success was 95%, with 4.1% PCI-related complications, and 1.6% post-PCI bleeding events. The vast majority of the study patients (99%) were discharged with dual anti-platelet therapy.
Conclusion: In this study, we observed a high level of adherence to the currently accepted guidelines in the current PCI practice on ACS patients in Iran. Also we found our practice is highly in line with the global reduction trend in the PCI-related complications.
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Affiliation(s)
- Seyed Hashem Sezavar
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Hassanzadeh
- Department of Internal Medicine, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Massoud Ghasemi
- Department of Cardiology, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | | | | - Ali Asghar Akhlaghi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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25
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Crowhurst JA, Whitby M, Aroney N, Dautov R, Walters D, Raffel O. Primary operator radiation dose in the cardiac catheter laboratory. Br J Radiol 2020; 93:20200018. [PMID: 32543896 DOI: 10.1259/bjr.20200018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Radiation from cardiac angiography procedures is harmful to patients and the staff performing them. This study sought to investigate operator radiation dose for a range of procedures and different operators in order to investigate trends and optimise dose. METHODS Real-time dosemeters (RTDs) were worn by operators for angiography procedures for 3 years. Dose-area product (DAP) and RTD were collected. RTD was normalised to DAP (RTD/DAP) to compare radiation dose and radiation protection measures. Comparisons were made across procedure categories and individual operators. RESULTS In 7626 procedures, median and 75th percentile levels were established for operator dose for 8 procedure categories. There was a significant difference in all operator dose measures and DAP across procedure categories (p<0.001). DAP, RTD, and RTD/DAP were significantly different across 22 individual operators (p<0.001). CONCLUSION DAP was significantly different across procedure categories and a higher RTD was seen with higher DAP. RTD/DAP can demonstrate radiation protection effectiveness and identified differences between procedures and individual operators with this measure. Procedures and individuals were identified where further optimisation of radiation protection measures may be beneficial. A reference level for operator dose can be created and audited against on a regular basis. ADVANCES IN KNOWLEDGE This study demonstrates that operator dose can be easily and routinely measured on a case by case basis to investigate dose trends for different procedures. Normalising the operator dose to DAP demonstrates radiation protection effectiveness for the individual operator which can then be optimised as part of an ongoing audit program.
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Affiliation(s)
- James A Crowhurst
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mark Whitby
- University of Queensland, St Lucia, Brisbane, Australia.,I-MED Radiology, Newstead, Queensland, Australia
| | - Nicholas Aroney
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia
| | - Rustem Dautov
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia
| | - Darren Walters
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia.,St Vincents Northside Private Hospital, Chermside, Queensland, Australia
| | - Owen Raffel
- The Prince Charles Hospital, Chermside, Queensland, Australia.,University of Queensland, St Lucia, Brisbane, Australia
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26
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Sciahbasi A, Babbaro M, Confessore P, Cera M, Di Russo C, Patrizi R, Fedele S. Vascular access and radiation exposure during percutaneous coronary procedures. Minerva Cardioangiol 2020; 68:592-598. [PMID: 32326678 DOI: 10.23736/s0026-4725.20.05165-8] [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
In the cardiology community, the use of transradial access for percutaneous coronary procedures is progressively increasing all around the world overtaking the use of transfemoral access. The advantages of the transradial access are based on a significant reduction in bleeding and vascular events compared to the femoral access and on a reduction in mortality in the setting of acute coronary syndromes. However, in recent years a slight but significant increase in radiation exposure for patients and operators associated with the radial approach has been detected, increasing concerns about possible long term increased stochastic risk. In particular interventional cardiologists are among physicians performing interventional procedures using X-rays, those exposed to the highest radiation dose during their activity and this exposure is not without possible long-term clinical consequences in term of deterministic and stochastic effects. All the operators should be aware of these risks and manage to reduce their radiation exposure. In this review we analysed the differences in term of radiation exposure comparing the radial and the femoral access for percutaneous coronary procedures. Then, we discussed the possible clinical consequences of these differences and finally we showed the available tools aimed to reduce the operator radiation exposure. In particular the use of adjunctive protective drapes placed on the patient might reduce operator radiation exposure in up to 81% of the dose.
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Affiliation(s)
- Alessandro Sciahbasi
- Department of Interventional Cardiology, Sandro Pertini Hospital, ASL RM2, Rome, Italy -
| | - Mario Babbaro
- Unit of Cardiology, Sant'Andrea Hospital, Rome, Italy
| | - Pierpaolo Confessore
- Department of Interventional Cardiology, Sandro Pertini Hospital, ASL RM2, Rome, Italy
| | - Maria Cera
- Department of Interventional Cardiology, Sandro Pertini Hospital, ASL RM2, Rome, Italy
| | - Cristian Di Russo
- Department of Interventional Cardiology, Sandro Pertini Hospital, ASL RM2, Rome, Italy
| | - Roberto Patrizi
- Department of Interventional Cardiology, Sandro Pertini Hospital, ASL RM2, Rome, Italy
| | - Silvio Fedele
- Department of Interventional Cardiology, Sandro Pertini Hospital, ASL RM2, Rome, Italy
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27
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EDITORIAL: Zero-Emission Cars Are Here: How Long Until a Zero-Radiation Cath Lab? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:12-13. [PMID: 32057350 DOI: 10.1016/j.carrev.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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28
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Is trans-radial approach related to an increased risk of radiation exposure in patients who underwent diagnostic coronary angiography or percutaneous coronary intervention? (The SAKARYA study). Anatol J Cardiol 2020; 22:5-12. [PMID: 31264653 PMCID: PMC6683214 DOI: 10.14744/anatoljcardiol.2019.06013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE It is still debatable whether diagnostic coronary angiography (CA) or percutaneous coronary interventions (PCIs) increase radiation exposure when performed via radial approach as compared to femoral approach. This question was investigated in this study by comparison of dose-area product (DAP), reference air kerma (RAK), and fluoroscopy time (FT) among radial and femoral approaches. METHODS All coronary procedures between November 2015 and November 2017 were assessed; and 4215 coronary procedures were enrolled in the study. Patients with bifurcation, chronic total occlusion, cardiogenic shock, or prior coronary artery bypass surgery were excluded. These 4215 procedures were evaluated for three different categories: diagnostic CA (Group I), PCI in patients with stable angina (Group II), and PCI in patients with ACS (Group III). RESULTS Age was significantly higher in the femoral arm of all groups. Among patients in the radial arm of Groups I and II, males were over-represented. Therefore, a multiple linear regression analysis with stepwise method was performed. After adjusting these clinical confounders, there was no significant difference with regard to DAP, RAK, and FT between femoral and radial access in Group I. In contrast, PCI via radial access was significantly associated with increased DAP, RAK, and FT in Groups II and III. CONCLUSION In spite of an increased experience with trans-radial approach, PCI of coronary lesions via radial route was associated with a relatively small but significant radiation exposure in our study. Compared to femoral access, diagnostic CA via radial access was not related to an increased radiation exposure.
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29
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Safirstein JG. Optimizing Transradial Access: Radiation, Contrast, Access Site Crossover, and Ergonomics. Interv Cardiol Clin 2020; 9:99-105. [PMID: 31733745 DOI: 10.1016/j.iccl.2019.08.001] [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] [Indexed: 06/10/2023]
Abstract
This article summarizes the data comparing radiation exposure and contrast use between transradial and transfemoral cardiac catheterizations. It also reviews the important features that may predict access site failure and crossover. In addition, it reviews the concept of ergonomics in the catheterization laboratory and how clinicians can improve the transradial approach.
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Affiliation(s)
- Jordan G Safirstein
- Department of Cardiology, Transradial Intervention, Morristown Medical Center, Meade Level B, 100 Madison Avenue, Morristown, NJ 07960, USA.
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30
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Abstract
Peripheral vascular intervention (PVI) improves quality of life and reduces major adverse limb events in patients with peripheral arterial disease. PVI is commonly performed via the femoral artery, and the most common adverse periprocedural event is a vascular access complication. Transradial access for PVI has the potential to reduce vascular access complications and improve patient outcomes. Further study is needed to elucidate the risks of stroke, acute kidney injury, and radiation exposure in the setting of transradial PVI. As transradial access for PVI progresses, it will be important to build the evidence base along with procedural experience.
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Affiliation(s)
| | - Sunil V Rao
- Division of Cardiology, Duke Clinical Research Institute, Duke University, 200 Morris Street, Durham, NC 27701, USA
| | - Rajesh V Swaminathan
- Division of Cardiology, Duke Clinical Research Institute, Duke University, 200 Morris Street, Durham, NC 27701, USA
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31
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Chivot C, Bouzerar R, Yzet T. Transitioning to Transradial Access for Cerebral Aneurysm Embolization. AJNR Am J Neuroradiol 2019; 40:1947-1953. [PMID: 31582386 PMCID: PMC6975100 DOI: 10.3174/ajnr.a6234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/13/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Despite several retrospective studies showing the safety and efficacy of transradial access for cerebral angiography, neurointerventionalists are apprehensive about implementing TRA for neurointerventions. This reluctance is mainly due to anatomic factors, technical factors, and a long learning curve (relative to transfemoral access). We present here our experience of TRA transition for cerebral aneurysm embolization. Our aim was to demonstrate the feasibility and safety of radial access for consecutive embolizations of ruptured and unruptured cerebral aneurysms. MATERIALS AND METHODS We performed a retrospective review of a prospective data base on cerebral aneurysm embolizations. Between April and December 2018, radial access was considered for all consecutive patients referred to our institution for cerebral aneurysm embolization. Technical success was defined as radial access with insertion of the sheath and completion of the intervention without a crossover to conventional femoral access. The primary safety end point was the in-hospital plus 30-day incidence of radial artery occlusion. Secondary end points included intraoperative complications and neurologic complications at discharge and in the following 30 days. RESULTS Seventy-one patients with a cerebral aneurysm underwent 73 embolization procedures at our institution. The first-choice access route was the radial artery in 62 patients (87.3%) and the femoral artery in 9 (12.6%). Thirty-four embolizations were performed using coils, 22 used a balloon-assisted coil technique, 6 used a stent-assisted coil technique, and 2 used a flow diverter. Crossover to femoral access was observed in 2 patients (3.1%). Four patients developed coil-induced thrombi requiring intra-arterial tirofiban injections. In 1 case, an aneurysm ruptured during the operation but did not have a clinical impact. No cases of radial artery occlusion or hand ischemia were observed. CONCLUSIONS A transition to radial access for cerebral aneurysm embolization is feasible and does not increase the level of risk associated with the procedure.
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Affiliation(s)
- C Chivot
- From the Departments of Radiology (C.C., T.Y.)
| | - R Bouzerar
- Image Processing (R.B.), Amiens University Hospital, Amiens, France
| | - T Yzet
- From the Departments of Radiology (C.C., T.Y.)
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32
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Radial Artery Access for Percutaneous Cardiovascular Interventions: Contemporary Insights and Novel Approaches. J Clin Med 2019; 8:jcm8101727. [PMID: 31635342 PMCID: PMC6833028 DOI: 10.3390/jcm8101727] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/12/2019] [Indexed: 12/11/2022] Open
Abstract
Since its introduction, the transradial access for percutaneous cardiovascular procedures has been associated with several advantages as compared to transfemoral approach, and has become the default for coronary angiography and intervention. In the last 30 years, a robust amount of evidence on the transradial approach has been mounted, promoting its diffusion worldwide. This article provides a comprehensive review of radial artery access for percutaneous cardiovascular interventions, including the evidence from clinical trials of transradial vs. transfemoral approach, technical considerations, access-site complications and limitations, alternative forearm accesses (e.g., ulnar and distal radial artery), and ultimately the use of the radial approach for structural interventions.
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33
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Mason PJ, Shah B, Tamis-Holland JE, Bittl JA, Cohen MG, Safirstein J, Drachman DE, Valle JA, Rhodes D, Gilchrist IC. An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association. Circ Cardiovasc Interv 2019; 11:e000035. [PMID: 30354598 DOI: 10.1161/hcv.0000000000000035] [Citation(s) in RCA: 304] [Impact Index Per Article: 60.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Transradial artery access for percutaneous coronary intervention is associated with lower bleeding and vascular complications than transfemoral artery access, especially in patients with acute coronary syndromes. A growing body of evidence supports adoption of transradial artery access to improve acute coronary syndrome-related outcomes, to improve healthcare quality, and to reduce cost. The purpose of this scientific statement is to propose and support a "radial-first" strategy in the United States for patients with acute coronary syndromes. This document also provides an update to previously published statements on transradial artery access technique and best practices, particularly as they relate to the management of patients with acute coronary syndromes.
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34
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Rychlik J, Hornacek I, Tejc M, Petrikovits E, Klimsa Z. Retrospective analysis of coronary interventions in a single centre and comparison of specific differences between radial and femoral access. Acta Cardiol 2019; 74:325-330. [PMID: 30193077 DOI: 10.1080/00015385.2018.1494115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: The aim of this study was to analyse the consequence of radial or femoral access during coronary interventions to radiation dose, fluorography time and a number of pseudoaneurysms following each type of intervention. Background: According to the results of many recent studies (RIVAL, RIFLE-STEACS, STEMI RADIAL), current guidelines favour radial over femoral access during coronary intervention for safety, especially in cases of acute coronary syndromes. However, several papers have referred to problems in the design of these studies and the management of antithrombotic therapy. The influence of access site on radiation dose and fluorography time is also still unclear. Methods: We retrospectively analysed 4522 patients who underwent coronary angiography in 2012 and 2016 in a single centre in the Czech Republic. We compared the access site with the average radiation dose and mean effective dose that each patient received in Gy/cm2 or mSv, respectively. We also compared average fluorography time in minutes and the incidence of pseudoaneurysms. Results: The radiation dose was a body mass index (BMI)-dependent parameter since each five points of body mass index increased radiation dose approximately by 23%. Use of femoral access resulted in lower fluorography time in all subgroups (p < .001) and decreased radiation dose in patients with coronary artery bypass grafts (CABGs) by 26% (p = .044). On the other hand, there has been 16 times lower frequency (p < .001) of post-catheterisation pseudoaneurysms after radial access than after femoral access. Conclusions: Both the radiation dose and fluorography time were lower after femoral access compared to radial access in patients with CABGs. On the other hand, radial access led to significantly fewer periprocedural pseudoaneurysms. Radial access therefore should be considered as the preferred access site during coronary intervention in patients with a high risk of pseudoaneurysm development, and femoral access should be considered for patients with a high risk of contrast-induced nephropathy.
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Affiliation(s)
- Jakub Rychlik
- Department of Cardiology, Jihlava Hospital, Jihlava, Czech Republic
| | | | | | | | - Zdenek Klimsa
- Department of Cardiology, Jihlava Hospital, Jihlava, Czech Republic
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35
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Crowhurst JA, Scalia GM, Whitby M, Murdoch D, Robinson BJ, Turner A, Johnston L, Margale S, Natani S, Clarke A, Burstow DJ, Raffel OC, Walters DL. Radiation Exposure of Operators Performing Transesophageal Echocardiography During Percutaneous Structural Cardiac Interventions. J Am Coll Cardiol 2019; 71:1246-1254. [PMID: 29544609 DOI: 10.1016/j.jacc.2018.01.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transesophageal echocardiography operators (TEEOP) provide critical imaging support for percutaneous structural cardiac intervention procedures. They stand close to the patient and the associated scattered radiation. OBJECTIVES This study sought to investigate TEEOP radiation dose during percutaneous structural cardiac intervention. METHODS Key personnel (TEEOP, anesthetist, primary operator [OP1], and secondary operator) wore instantly downloadable personal dosimeters during procedures requiring TEE support. TEEOP effective dose (E) and E per unit Kerma area product (E/KAP) were calculated. E/KAP was compared with C-arm projections. Additional shielding for TEEOP was implemented, and doses were measured for a further 50 procedures. Multivariate linear regression was performed to investigate independent predictors of radiation dose reduction. RESULTS In the initial 98 procedures, median TEEOP E was 2.62 μSv (interquartile range [IQR]: 0.95 to 4.76 μSv), similar to OP1 E: 1.91 μSv (IQR: 0.48 to 3.81 μSv) (p = 0.101), but significantly higher than secondary operator E: 0.48 μSv (IQR: 0.00 to 1.91 μSv) (p < 0.001) and anesthetist E: 0.48 μSv (IQR: 0.00 to 1.43 μSv) (p < 0.001). Procedures using predominantly right anterior oblique (RAO) and steep RAO projections were associated with high TEEOP E/KAP (p = 0.041). In a further 50 procedures, with additional TEEOP shielding, TEEOP E was reduced by 82% (2.62 μSv [IQR: 0.95 to 4.76] to 0.48 μSv [IQR: 0.00 to 1.43 μSv] [p < 0.001]). Multivariate regression demonstrated shielding, procedure type, and KAP as independent predictors of TEEOP dose. CONCLUSION TEE operators are exposed to a radiation dose that is at least as high as that of OP1 during percutaneous cardiac intervention. Doses were higher with procedures using predominantly RAO projections. Radiation doses can be significantly reduced with the use of an additional ceiling-suspended lead shield.
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Affiliation(s)
- James A Crowhurst
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St. Lucia, Queensland, Australia.
| | - Gregory M Scalia
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St. Lucia, Queensland, Australia
| | - Mark Whitby
- Biomedical Technical Services, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Dale Murdoch
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St. Lucia, Queensland, Australia
| | - Brendan J Robinson
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Arianwen Turner
- Medical Imaging Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Liesie Johnston
- Medical Imaging Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Swaroop Margale
- Department of Anaesthesia, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Sarvesh Natani
- Department of Anaesthesia, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Andrew Clarke
- Department of Cardio-thoracic Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Darryl J Burstow
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St. Lucia, Queensland, Australia
| | - Owen C Raffel
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St. Lucia, Queensland, Australia
| | - Darren L Walters
- Cardiology Department, The Prince Charles Hospital, Chermside, Queensland, Australia; University of Queensland, St. Lucia, Queensland, Australia
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Hirshfeld JW, Fiorilli PN, Silvestry FE. Important Strategies to Reduce Occupational Radiation Exposure in the Cardiac Catheterization Laboratory: No Lower Limit. J Am Coll Cardiol 2019; 71:1255-1258. [PMID: 29544610 DOI: 10.1016/j.jacc.2018.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 01/29/2023]
Affiliation(s)
- John W Hirshfeld
- Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Paul N Fiorilli
- Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Frank E Silvestry
- Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Kinnaird T, Anderson R, Gallagher S, Cockburn J, Sirker A, Ludman P, de Belder M, Copt S, Nolan J, Zaman A, Mamas M. Vascular Access Site and Outcomes in 58,870 Patients Undergoing Percutaneous Coronary Intervention With a Previous History of Coronary Bypass Surgery: Results From the British Cardiovascular Interventions Society National Database. JACC Cardiovasc Interv 2019. [PMID: 29519382 DOI: 10.1016/j.jcin.2017.12.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Using the British Cardiovascular Intervention Society percutaneous coronary intervention (PCI) database, access site choice and outcomes of patients undergoing PCI with previous coronary artery bypass grafting (CABG) were studied. BACKGROUND Given the influence of access site on outcomes, use of radial access in PCI-CABG warrants further investigation. METHODS Data were analyzed from 58,870 PCI-CABG procedures performed between 2005 and 2014. Multivariate logistic regression was used to identify predictors of access site choice and its association with outcomes. RESULTS The number of PCI-CABG cases and the percentage of total PCI increased significantly during the study period. Femoral artery (FA) utilization fell from 90.8% in 2005 to 57.6% in 2014 (p < 0.001), with no differences in the rate of change of left versus right radial use. In contemporary study years (2012 to 2014), female sex, acute coronary syndrome presentation, chronic total occlusion intervention, and lower operator volume were independently associated with FA access. Length of stay was shortened in the radial cohort. Unadjusted outcomes including an access site complication (1.10% vs. 0.30%; p < 0.001), blood transfusion (0.20% vs. 0.04%; p < 0.001), major bleeding (1.30% vs. 0.40%; p < 0.001), and in-hospital death (1.10% vs. 0.60%; p = 0.001) were more likely to occur with FA access compared with radial access. After adjustment, although arterial complications, transfusion, and major bleeding remained more common with FA use, short- and longer-term mortality and major adverse cardiac event rates were similar. CONCLUSIONS In contemporary practice, FA access remains predominant during PCI-CABG with case complexity associated with it use. FA use was associated with longer length of stay, and higher rates of vascular complications, major bleeding, and transfusion.
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Affiliation(s)
- Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom; Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom.
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | - Sean Gallagher
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | - James Cockburn
- Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Alex Sirker
- Department of Cardiology, University College Hospital, London, United Kingdom
| | - Peter Ludman
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Mark de Belder
- Department of Cardiology, James Cook University Hospital, Middlesbrough, United Kingdom
| | | | - James Nolan
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom
| | - Azfar Zaman
- Department of Cardiology, Freeman Hospital, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke Hospital, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom
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Kobayashi T, Hirshfeld JW. Radiation Exposure in Cardiac Catheterization: Operator Behavior Matters. Circ Cardiovasc Interv 2019; 10:CIRCINTERVENTIONS.117.005689. [PMID: 28801543 DOI: 10.1161/circinterventions.117.005689] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Taisei Kobayashi
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia (T.K., J.W.H.); and Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania (T.K.)
| | - John W Hirshfeld
- From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia (T.K., J.W.H.); and Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania (T.K.).
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Balaban Y, Akbaş MH, Akbaş ML, Özerdem A. Efficacy and Safety of "Coronary Artery Bypass Graft Angiography" with Right Transradial Access versus Left Transradial Access and Femoral Access: a Retrospective Comparative Study. Braz J Cardiovasc Surg 2019; 34:48-56. [PMID: 30810674 PMCID: PMC6385842 DOI: 10.21470/1678-9741-2018-0270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/14/2018] [Indexed: 12/01/2022] Open
Abstract
Objective Over the past 10 years, the rate of patients who have undergone coronary
artery bypass graft (CABG) surgery has increased twofold in cases of
coronary angiography. Today, transradial access is the first choice for
coronary angiography. We aimed to compare the efficacy and reliability of
radial versus femoral access for coronary angiography in
post-CABG surgery in this study. Methods Data from 442 patients who underwent post-CABG surgery between 2012-2017 were
retrospectively compared. The right radial route was used in 120 cases, the
left radial route in 148, and femoral route in 174. These three pathways
were compared in terms of procedure time and fluoroscopy time, efficacy, and
complication development. Comparisons among the three groups were performed
with Bonferroni test for continuous variables and chi-square or Fisher's
exact test for nominal variables as a binary. Results Comparison results indicate that femoral access was better than left radial
access and the left radial access was better than right radial access in
terms of fluoroscopy time (10.71±1.65, 10.94±1.25,
16.12±5.28 min, P<0.001) and total procedure time
(17.28±1.68, 17.68±2.34, 23.04±5.84 min,
P<0.001). The left radial pathway was the most
effective way of viewing left internal mammary artery (LIMA). No
statistically significant differences were found among the three groups in
other graft visualizations, all minor complications, total procedure and
fluoroscopy time "Except LIMA imaging". Mortality due to
processing was not observed in all three groups. Conclusion The left radial route is preferred over right radial access for post-CABG
angiography because the left radial pathway is close to the LIMA and is
similar to the femoral pathway. In LIMA graft imaging, right radial access
is a reliable route, even though it is not as effective as other pathways.
We hope that the right radial pathway will improve with physician experience
and innovations.
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Affiliation(s)
- Yakup Balaban
- Department of Cardiology, Vm Medicalpark Kocaeli Hospital, Başiskele, Kocaeli, Turkey
| | - Mustafa Haluk Akbaş
- Department of Cardiology, Vm Medicalpark Kocaeli Hospital, Başiskele, Kocaeli, Turkey
| | | | - Ali Özerdem
- Department of Cardiology, Vm Medicalpark Kocaeli Hospital, Başiskele, Kocaeli, Turkey
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Crowhurst JA, Whitby M, Savage M, Murdoch D, Robinson B, Shaw E, Gaikwad N, Saireddy R, Hay K, Walters DL. Factors contributing to radiation dose for patients and operators during diagnostic cardiac angiography. J Med Radiat Sci 2019; 66:20-29. [PMID: 30488575 PMCID: PMC6399189 DOI: 10.1002/jmrs.315] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/27/2018] [Accepted: 10/31/2018] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Diagnostic coronary angiography (CA) uses ionising radiation with relatively high doses, which impact on both patients and staff. This study sought to identify which patient and procedural factors impact patient and operator dose the most during CA. METHODS Patient and procedure related variables impacting on Kerma area product (PKA ) and operator dose (OD) were collected for 16 months. Procedures were separated into 10 different procedure categories. PKA was used for patient dose and OD was measured with an instantly downloadable dosimeter (IDD) - downloaded at the end of each procedure. High and low radiation dose was defined by binary variables based on the 75th percentile of the continuous measures. Univariate and multivariate regression were used to identify predictors. RESULTS Of 3860 patients included, the IDD was worn for 2591 (61.7%). Obesity (BMI > 30 compared to BMI < 25) was the strongest predictor for both a PKA (odds ratio (OR) = 19.1 (95% CI 13.5-26.9) P < 0.001) and OD (OR = 3.3 (2.4-4.4) P < 0.001) above the 75th percentile. Male gender, biplane imaging, the X-ray unit used, operator experience and procedure type also predicted a high PKA . Radial access, male gender, biplane imaging and procedure type also predicted a high OD. CONCLUSION Radiation dose during CA is multifactorial and is dependent on patient and procedure related variables. Many factors impact on both PKA and OD but obesity is the strongest predictor for both patients and operators to receive a high radiation dose.
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Affiliation(s)
- James A. Crowhurst
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
- Medical Imaging DepartmentThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Mark Whitby
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
- Bio‐Medical Technical ServicesThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Michael Savage
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
| | - Dale Murdoch
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
| | - Brendan Robinson
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- Medical Imaging DepartmentThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Elizabeth Shaw
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Niranjan Gaikwad
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
| | - Ramkrishna Saireddy
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- Cairns Base HospitalCairnsQueenslandAustralia
| | - Karen Hay
- QIMR Berghofer Medical Research InstituteHerstonQueenslandAustralia
| | - Darren L. Walters
- Heart and Lung ProgramThe Prince Charles HospitalChermsideQueenslandAustralia
- University of QueenslandSt LuciaQueenslandAustralia
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Safety and efficacy of radial versus femoral access for rotational Atherectomy: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:241-247. [DOI: 10.1016/j.carrev.2018.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/07/2018] [Accepted: 06/07/2018] [Indexed: 12/29/2022]
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Impact of radial and femoral access on radiation dose and fluorography time in patients with acute coronary syndrome. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Deora S. Transradial approach - Female population and radiation exposure an important aspect. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:985-986. [PMID: 30045815 DOI: 10.1016/j.carrev.2018.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Surender Deora
- All India Institute of Medical Sciences, Jodhpur, Rajasthan 342005, India.
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Lee BK. Transradial intervention as the first choice of treatment for ST elevation myocardial infarction patients: editorial comment. Korean J Intern Med 2018; 33:691-692. [PMID: 29961310 PMCID: PMC6030421 DOI: 10.3904/kjim.2018.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 06/20/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Byoung Kwon Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Correspondence to Byoung Kwon Lee, M.D. Department of Internal Medicine, Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea Tel: +82-2-2019-3307 Fax: +82-2-3463-3882 E-mail:
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Sciahbasi A, Sarandrea A, Rigattieri S, Patrizi R, Cera M, Di Russo C, Perone F, Porretta V, Fedele S, Romano S, Penco M, Ferraiuolo G. Staff radiation dose during percutaneous coronary procedures: Role of adjunctive protective drapes. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:755-758. [PMID: 29691182 DOI: 10.1016/j.carrev.2018.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/03/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The use of adjunctive protective drapes placed on the patient protects the operating physician from scatter radiation during percutaneous coronary procedures (PCP). No data are available on the effect of these drapes for staff members' radio-protection. PURPOSE To evaluate staff radiation exposure during PCP and the effect of adjunctive protective drapes on dose reduction. METHODS The RADIANT study (NCT01974453) is a prospective, observational study evaluating operator radiation exposure during PCP using electronic dosimeter. In a sub-group of procedures all the staff members (II operator, nurse circulator and technologist) were also equipped with a dedicated electronic dosimeter. RESULTS From a total of 2028 procedures included in the RADIANT study, staff members' doses were available for 122 procedures (67 coronarography and 55 percutaneous coronary interventions). Median fluoroscopy time was 306 s (Interquartile range 155-526 s) and the dose area product (DAP) was 18.0 Gy*cm2 (10-35.5 Gy*cm2). The radiation exposure was highest for the operating physician (6.7 μSv) and progressively lower for the nurse circulator (1.8 μSv), the II operator (1 μSv) and the technologist (0.7 μSv, p < 0.001). Protective pelvic drapes were used in 43 procedures and associated with a lower radiation exposure for all staff members (14 μSv vs 2.2 μSv for operating physician, p < 0.001, 1.7 μSv vs 0.49 μSv for II operator, p < 0.001, 2.16 μSv vs 0.93 μSv for nurse circulator, p = 0.02 and 0.85 μSv vs 0.39 μSv for technologist, p = 0.01). CONCLUSIONS The use of adjunctive protective drapes is effective in reducing radiation protection for all staff members during PCP.
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Affiliation(s)
| | | | | | - Roberto Patrizi
- Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy
| | - Maria Cera
- Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy
| | | | | | | | - Silvio Fedele
- Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy
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Kolkailah AA, Alreshq RS, Muhammed AM, Zahran ME, Anas El‐Wegoud M, Nabhan AF. Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in people with coronary artery disease. Cochrane Database Syst Rev 2018; 4:CD012318. [PMID: 29665617 PMCID: PMC6494633 DOI: 10.1002/14651858.cd012318.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the major cause of mortality worldwide. Coronary artery disease (CAD) contributes to half of mortalities caused by CVD. The mainstay of management of CAD is medical therapy and revascularisation. Revascularisation can be achieved via coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Peripheral arteries, such as the femoral or radial artery, provide the access to the coronary arteries to perform diagnostic or therapeutic (or both) procedures. OBJECTIVES To assess the benefits and harms of the transradial compared to the transfemoral approach in people with CAD undergoing diagnostic coronary angiography (CA) or PCI (or both). SEARCH METHODS We searched the following databases for randomised controlled trials on 10 October 2017: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Web of Science Core Collection. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform in August 2017. There were no language restrictions. Reference lists were also checked and we contacted authors of included studies for further information. SELECTION CRITERIA We included randomised controlled trials that compared transradial and transfemoral approaches in adults (18 years of age or older) undergoing diagnostic CA or PCI (or both) for CAD. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. At least two authors independently screened trials, extracted data, and assessed the risk of bias in the included studies. We contacted trial authors for missing information. We used risk ratio (RR) for dichotomous outcomes and mean difference (MD) or standardised mean difference (SMD) for continuous data, with their 95% confidence intervals (CIs). All analyses were checked by another author. MAIN RESULTS We identified 31 studies (44 reports) including 27,071 participants and two ongoing studies. The risk of bias in the studies was low or unclear for several domains. Compared to the transfemoral approach, the transradial approach reduced short-term net adverse clinical events (NACE) (i.e. assessed during hospitalisation and up to 30 days of follow-up) (RR 0.76, 95% CI 0.61 to 0.94; 17,133 participants; 4 studies; moderate quality evidence), cardiac death (RR 0.69, 95% CI 0.54 to 0.88; 11,170 participants; 11 studies; moderate quality evidence). However, short-term myocardial infarction was similar between both groups (RR 0.91, 95% CI 0.81 to 1.02; 19,430 participants; 11 studies; high quality evidence). The transradial approach had a lower procedural success rate (RR 0.97, 95% CI 0.96 to 0.98; 25,920 participants; 28 studies; moderate quality evidence), but was associated with a lower risk of all-cause mortality (RR 0.77, 95% CI 0.62 to 0.95; 18,955 participants; 10 studies; high quality evidence), bleeding (RR 0.54, 95% CI 0.40 to 0.74; 23,043 participants; 20 studies; low quality evidence), and access site complications (RR 0.36, 95% CI 0.22 to 0.59; 16,112 participants; 24 studies; low quality evidence). AUTHORS' CONCLUSIONS Transradial approach for diagnostic CA or PCI (or both) in CAD may reduce short-term NACE, cardiac death, all-cause mortality, bleeding, and access site complications. There is insufficient evidence regarding the long-term clinical outcomes (i.e. beyond 30 days of follow-up).
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Affiliation(s)
- Ahmed A Kolkailah
- John H. Stroger, Jr. Hospital of Cook CountyDepartment of MedicineChicagoILUSA
| | | | - Ahmed M Muhammed
- Faculty of Medicine, Ain Shams UniversityDepartment of CardiologyCairoEgypt
| | - Mohamed E Zahran
- Faculty of Medicine, Ain Shams UniversityDepartment of CardiologyCairoEgypt
| | - Marwah Anas El‐Wegoud
- Egyptian Center for Evidence Based Medicine (ECEBM)8 Masaken Hayet El Tadrees Ain Shams University, El Khalifa El Maamoun St.CairoEgypt11646
| | - Ashraf F Nabhan
- Ain Shams UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine16 Ali Fahmi Kamel StreetHeliopolisCairoEgypt11351
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Schoenfeld MS, Kassas I, Shah B. Transradial Artery Access in Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:11. [PMID: 29478085 DOI: 10.1007/s11936-018-0607-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Early revascularization is the gold standard for management of patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock (CS). The use of transradial artery access (TRA) in percutaneous coronary intervention (PCI) has increased in recent years and has emerged as a safe and effective approach to PCI in high-risk patients, with advantages in reduced major bleeding events, other peri-procedural complications, and all-cause mortality when compared with transfemoral artery access (TFA). Multiple randomized clinical trials have demonstrated these advantages of TRA vs. TFA PCI in STEMI patients. Although there remains a lack of dedicated randomized trials in CS, observational data suggest benefits on the same endpoints as in STEMI with TRA vs. TFA PCI in CS. This review summarizes the existing literature on the use of TRA compared to TFA for STEMI and CS patients; the reduction of major bleeding events, other peri-procedural complications, and mortality associated with TRA in STEMI and CS; and technical considerations and challenges in the care of these high-risk patient populations.
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Affiliation(s)
- Matthew S Schoenfeld
- New York University School of Medicine, 530 First Avenue, HCC-14, New York, NY, 10016, USA
| | - Ibrahim Kassas
- New York University School of Medicine, 530 First Avenue, HCC-14, New York, NY, 10016, USA
| | - Binita Shah
- VA New York Harbor Healthcare System, Manhattan Campus, New York University School of Medicine, 423 E 23rd Street, Room 12023-W, New York, NY, 10010, USA.
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Sciahbasi A, Frigoli E, Sarandrea A, Calabrò P, Rubartelli P, Cortese B, Tomassini F, Zavalloni D, Tebaldi M, Calabria P, Rigattieri S, Zingarelli A, Sardella G, Lupi A, Rothenbühler M, Heg D, Valgimigli M. Determinants of radiation dose during right transradial access: Insights from the RAD-MATRIX study. Am Heart J 2018; 196:113-118. [PMID: 29421003 DOI: 10.1016/j.ahj.2017.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The RAD-MATRIX trial reported a large operator radiation exposure variability in right radial percutaneous coronary procedures. The reasons of these differences are not well understood. Our aim was to appraise the determinants of operator radiation exposure during coronary right transradial procedures. METHODS Patient arrangement during transradial intervention was investigated across operators involved in the RAD-MATRIX trial. Operator radiation exposure was analyzed according to the position of the patient right arm (close or far from the body) and in relation to the size of the upper leaded glass. RESULTS Among the 14 operators who agreed to participate, there was a greater than 10-fold difference in radiation dose at thorax level (from 21.5 to 267 μSv) that persisted after normalization by dose-area product (from 0.35 to 3.5 μSv/Gy*cm2). Among the operators who positioned the instrumented right arm far from the body (110.4 μSv, interquartile range 71.5-146.5 μSv), thorax dose was greater than that in those who placed the instrumented arm close to the right leg (46.1 μSv, 31.3-56.8 μSv, P = .02). This difference persisted after normalization by dose-area product (P = .028). The use of a smaller full glass shield was also associated with a higher radiation exposure compared with a larger composite shield (147.5 and 60 μSv, respectively, P = .016). CONCLUSIONS In the context of the biggest radiation study conducted in patients undergoing transradial catheterization, the instrumented right arm arrangement close to the leg and greater upper leaded shield dimensions were associated with a lower operator radiation exposure. Our findings emphasize the importance of implementing simple preventive measures to mitigate the extra risks of radiation exposure with right radial as compared with femoral access.
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49
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Fuster V. Editor-in-Chief's Top Picks From 2017. J Am Coll Cardiol 2018; 71:890-934. [PMID: 29471941 DOI: 10.1016/j.jacc.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Each week, I record audio summaries for every article in JACC, as well as an issue summary. While this process has been time-consuming, I have become quite familiar with every paper that we publish. Thus, I personally select papers (both original investigations and review articles) from 15 distinct specialties each year for your review. In addition to my personal choices, I have included manuscripts that have been the most accessed or downloaded on our websites, as well as those selected by the JACC Editorial Board members. In order to present the full breadth of this important research in a consumable fashion, we will present these manuscripts in this issue of JACC. The highlights comprise the following sections: Basic & Translational Research, Cardiac Failure, Cardiomyopathies/Myocardial & Pericardial Diseases, Cardio-oncology, Congenital Heart Disease, Coronary Disease & Interventions, CVD Prevention & Health Promotion, Hypertension, Imaging, Metabolic & Lipid Disorders, Rhythm Disorders, Valvular Heart Disease, and Vascular Medicine (1-110).
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50
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Langer C, Riehle J, Wuttig H, Dürrwald S, Lange H, Samol A, Frey N, Wiemer M. Efficacy of a one-catheter concept for transradial coronary angiography. PLoS One 2018; 13:e0189899. [PMID: 29293533 PMCID: PMC5749733 DOI: 10.1371/journal.pone.0189899] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/04/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Transradial coronary angiography (TRC) can be performed with a one-catheter approach for the right and left coronary ostium (R/LCO). We investigated the performance of a special diagnostic catheter widely used for the one-catheter-approach, the Tiger (Tiger II, TerumoTM). METHODS In a dual center registry we analyzed 1412 TRC-procedures exclusively performed by experienced TRC-operators. We compared the performance of the Tiger with Judkins catheters by retrospectively judging ostial catheter stability during contrast injection, and by measuring contrast use, fluoroscopy time (FT) and complication rate. RESULTS Poor or failed ostial engagement was found in 40.5% in the Tiger group, compared to 46.6% with the use of Judkins catheters (p<0.183). Ostial instability of the Tiger was found more often during engagement of the LCO than the RCO (34.4% vs. 10.8%, p<0.001), whereas it was similar in the LCO and RCO for Judkins catheters (27.4% vs. 26.7%, p = 0.840). TRC-procedures performed with Tiger catheters were associated with less contrast volume (63.48 ± 29.83mL vs. 82.51 ± 56.58mL, p<0.004) and shorter FT than with Judkins catheters. (198.27 ± 194.8sec vs. 326.85 ± 329.70sec). Forearm hematomas occurred less often with the Tiger (1.2% vs. 6.6%, p< 0.02). CONCLUSION The Tiger employed as a single catheter in TRC is an effective tool to achieve lower contrast volume and fluoroscopy time at a low complication rate. Unstable engagement affects predominantly the left coronary artery, but its overall frequency is similar for both, the Tiger and Judkins catheters.
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Affiliation(s)
- Christoph Langer
- Klinik für Innere Medizin III mit den Schwerpunkten Kardiologie, Angiologie und internistische Intensivmedizin Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Germany
- Kardiologische-Angiologische Praxis–Herzzentrum Bremen, Bremen, Germany
| | - Julia Riehle
- Klinik für Innere Medizin III mit den Schwerpunkten Kardiologie, Angiologie und internistische Intensivmedizin Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Germany
| | - Helge Wuttig
- Klinik für Kardiologie und Internistische Intensivmedizin, Johannes-Wesling-Klinikum Minden, Universitätsklinikum der Ruhr-Universität BochumHans-Nolte-Straße 1, Minden, Germany
| | - Stephanie Dürrwald
- Klinik für Kardiologie und Internistische Intensivmedizin, Johannes-Wesling-Klinikum Minden, Universitätsklinikum der Ruhr-Universität BochumHans-Nolte-Straße 1, Minden, Germany
| | - Helmut Lange
- Kardiologische-Angiologische Praxis–Herzzentrum Bremen, Bremen, Germany
| | - Alexander Samol
- Klinik für Kardiologie und Internistische Intensivmedizin, Johannes-Wesling-Klinikum Minden, Universitätsklinikum der Ruhr-Universität BochumHans-Nolte-Straße 1, Minden, Germany
| | - Norbert Frey
- Klinik für Innere Medizin III mit den Schwerpunkten Kardiologie, Angiologie und internistische Intensivmedizin Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Germany
| | - Marcus Wiemer
- Klinik für Kardiologie und Internistische Intensivmedizin, Johannes-Wesling-Klinikum Minden, Universitätsklinikum der Ruhr-Universität BochumHans-Nolte-Straße 1, Minden, Germany
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