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Guelker JE, Bufe A, Blockhaus C, Gesenberg J, Kuervers J, Kroeger K, Katoh M, Dinh W. Impact of body mass index on acute outcome in percutaneous coronary intervention of chronic total occlusion. J Saudi Heart Assoc 2019; 31:198-203. [PMID: 31360048 PMCID: PMC6642223 DOI: 10.1016/j.jsha.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/10/2019] [Accepted: 06/16/2019] [Indexed: 12/12/2022] Open
Abstract
Background Percutaneous coronary intervention (PCI) of total chronic total occlusion (CTO) still remains a major challenge in interventional cardiology. There is only insignificant knowledge reported in the literature about the influence of body mass index (BMI) on acute outcome, including success rates and complications in CTO-PCI. Methods Between 2012 and 2017, we included 508 patients. They underwent PCI for at least one CTO. Antegrade and retrograde CTO techniques were applied. The retrograde approach was used only after failed antegrade intervention. BMI was calculated according to the definitions of the World Health Organization. It was subdivided as normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), obese (30–34.9 kg/m2), and very obese (≥35 kg/m2). The Shapiro–Wilk test was used to test for normality of distribution. Continuous variables were tested for differences with Kruskal–Wallis or Mann–Whitney U test as appropriate. Categorical variables were tested with Fisher exact test. Results Out of the 508 patients, 77 (15.2%) had normal weight, 286 (56.3%) were overweight, 106 (20.9%) obese, and 39 (7.7%) very obese. Radiation dose and examination time increased with elevated BMI categories (p < 0.001, p = 0.026). Success rates were similar in all BMI categories (p = 0.645). In-hospital procedural complications were rare and showed no statistically significant difference (p = 0.185). Conclusions Our retrospective study suggests that there exists no significant association between overweight and acute outcome in patients undergoing CTO-PCI. It is safe and feasible to perform.
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Affiliation(s)
- Jan-Erik Guelker
- Heartcentre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, Krefeld, GermanyGermany.,Institute for Heart and Circulation Research, University Cologne, Cologne, GermanyGermany
| | - Alexander Bufe
- Heartcentre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, Krefeld, GermanyGermany.,Institute for Heart and Circulation Research, University Cologne, Cologne, GermanyGermany.,University Witten/Herdecke, Witten, GermanyGermany
| | - Christian Blockhaus
- Heartcentre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, Krefeld, GermanyGermany.,Institute for Heart and Circulation Research, University Cologne, Cologne, GermanyGermany
| | - Jan Gesenberg
- Heartcentre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, Krefeld, GermanyGermany.,Institute for Heart and Circulation Research, University Cologne, Cologne, GermanyGermany
| | - Julian Kuervers
- Heartcentre Niederrhein, Department of Cardiology, Helios Clinic Krefeld, Krefeld, GermanyGermany.,Institute for Heart and Circulation Research, University Cologne, Cologne, GermanyGermany
| | - Knut Kroeger
- Department of Angiology, Helios Clinic Krefeld, Krefeld, GermanyGermany
| | - Marcus Katoh
- Department of Diagnostic and Interventional Radiology, Helios Clinic Krefeld, Krefeld, GermanyGermany
| | - Wilfried Dinh
- University Witten/Herdecke, Witten, GermanyGermany.,Department of Cardiology, Helios Clinic Wuppertal, Wuppertal, GermanyGermany
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Guelker JE, Bufe A, Blockhaus C, Gesenberg J, Kuervers J, Ingerfurth K, Stein J, Bansemir L. Acute, in-Hospital Outcome of Percutaneous Coronary Intervention for In-Stent Chronic Total Occlusion. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:997-1000. [PMID: 30638887 DOI: 10.1016/j.carrev.2018.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/09/2018] [Accepted: 12/10/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) of total chronic total occlusion (CTO) still remains a major challenge in interventional cardiology. Recanalization of in-stent CTO (IS-CTO) is associated with inferior success rates. This present study aims to comparatively evaluate the acute outcome of patients with IS-CTO and de novo CTO. METHODS Between 2012 and 2018 we included 600 patients. Antegrade and retrograde CTO-PCI techniques were used and the primary endpoint was a composite safety endpoint comprising in-hospital death, vascular complications, cardiac tamponade, stroke and acute myocardial infarction. RESULTS IS-CTO predominantly occurred in the right coronary artery (71.2%). The success (p = 0.495) and complication rates (p = 0.255) were independent of the target vessel. The lesion lengths of IS-CTO were longer than in de-novo CTO (40 mm vs. 30 mm, statistical trend p = 0.081) alongside with the implanted stent lengths (76 mm vs. 63 mm, statistical trend p = 0.070) and their diameter (3.5 mm vs. 3.0 mm, p < 0.001). We determined that procedural and fluoroscopy time were longer in patients with IS-CTO (115.0 min vs. 93.0 min, p = 0.018 and 40.0 min vs. 30.0 min, p = 0.040) and that in this group of patients the amount of contrast medium was higher (250 ml vs. 200 ml, p = 0.015). Overall success rates were comparable between the two group of patients (87.9% vs. 84.4%, p = 0.586). In-hospital, acute procedural complications regarding the composite safety were rare and showed no statistically significant difference (3.0% vs. 5.6%; p = 0.563). CONCLUSIONS Recanalization of in-stent CTO lesions go along with long procedural and high fluoroscopy times as well as an increased amount of contrast medium. Compared to de novo CTO they can be performed safe in experienced hands with similar success rates.
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Affiliation(s)
- Jan-Erik Guelker
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany; Institute for Heart and Circulation Research, University Cologne, Cologne, Germany.
| | - Alexander Bufe
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany; Institute for Heart and Circulation Research, University Cologne, Cologne, Germany; University Witten/Herdecke, Witten, Germany
| | - Christian Blockhaus
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany; Institute for Heart and Circulation Research, University Cologne, Cologne, Germany
| | - Jan Gesenberg
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany; Institute for Heart and Circulation Research, University Cologne, Cologne, Germany
| | - Julian Kuervers
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany; Institute for Heart and Circulation Research, University Cologne, Cologne, Germany
| | - Klaus Ingerfurth
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany; Institute for Heart and Circulation Research, University Cologne, Cologne, Germany
| | - Johannes Stein
- Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany; Institute for Heart and Circulation Research, University Cologne, Cologne, Germany
| | - Lars Bansemir
- Department of Cardiology, Helios Clinic Velbert, Velbert, Germany
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[Negative angiographic markers in percutaneous coronary intervention of chronic total occlusions]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 88:93-99. [PMID: 28268135 DOI: 10.1016/j.acmx.2017.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/16/2017] [Accepted: 01/16/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study is to identify negative angiographic predictive variables and the presence of a side branch close to the distal cap of the occlusion in the chronic total occlusion percutaneous coronary intervention outcome. METHODS Potential negative angiographic variables were retrospectively evaluated in 156 chronic total occlusions that had undergone a percutaneous coronary intervention. Binary logistic regression with predictive purpose was used to identify a model of variables which, all in all, could successfully predict a negative intervention result. RESULTS Variables independently associated with the procedural failure were multivessel disease (odds ratio=5.12; 95% confidence interval (CI); 1.94-13.5; P=.001), ambiguous stump presence (odds ratio=5.08; 95% CI; 2.22-11.63 P<.001), occlusion length ≥20mm (odds ratio=3.7; 95% CI; 1.37-9.97 P=.01), and ostial location (odds ratio=6.53; 95% CI; 1.67-25.63; P=.007). Side branch at distal cap proximity did not remain in the predictive model. CONCLUSIONS Multivessel disease, ambiguous stump, a length ≥20mm, and an ostial location of a chronic total occlusion are independent predictive factors of an unfavourable angioplasty result. A side branch at occlusion distal cap was not associated with the procedural failure.
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Dash D. Complications encountered in coronary chronic total occlusion intervention: Prevention and bailout. Indian Heart J 2016; 68:737-746. [PMID: 27773418 PMCID: PMC5079195 DOI: 10.1016/j.ihj.2016.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 02/16/2016] [Accepted: 03/07/2016] [Indexed: 11/30/2022] Open
Abstract
Despite the continuing developments of improved medical devices and increasing operator expertize, coronary chronic total occlusion (CTO) remains as one of the most challenging lesion subsets in interventional cardiology. Percutaneous coronary intervention (PCI) of CTO is a complex procedure carrying the risk of complications that are responsible for significant morbidity and mortality. The complications can be classified as coronary (such as coronary occlusion, perforation, device embolization, or entrapment); cardiac non-coronary (such as periprocedural myocardial infarction); extra cardiac (such as vascular access complications, systemic embolization, contrast-induced nephropathy, and radiation-induced injury). Further, certain complications (such as donor vessel dissection or thrombosis) are unique to CTO-PCI. There are also complications related to specialized techniques, such as dissection/reentry and retrograde crossing techniques. A thorough understanding of the potential complications is critical to mitigate risk during these complex procedures.
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Affiliation(s)
- Debabrata Dash
- Interventional Cardiologist, S. L Raheja (A Fortis Associate) Hospital, Nanavati Superspeciality Hospital, Mumbai, India; Guest Professor of Cardiology, Beijing Tiantan Hospital, Beijing, China.
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Bosiers M, Diaz-Cartelle J, Scheinert D, Peeters P, Dawkins KD. Revascularization of lower extremity chronic total occlusions with a novel intraluminal recanalization device: results of the ReOpen study. J Endovasc Ther 2014; 21:61-70. [PMID: 24502485 DOI: 10.1583/12-4083r.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To report outcomes of a multicenter, nonrandomized study evaluating the safety and effectiveness of a guidewire-mounted mechanical recanalization device with a rotating distal tip (TruePath) in facilitating the crossing of infrainguinal chronic total occlusions (CTOs). METHODS Eligible patients had lower extremity ischemia and an angiographically confirmed occlusion, with no antegrade flow for at least 30 days, in an infrainguinal artery. Enrollment occurred when a previous or concurrent attempt to cross the CTO with a conventional guidewire had failed. A total of 85 patients with 85 lesions were enrolled; 61 (71.8%) target lesions were in the superficial femoral artery and 68 (80%) were considered moderately or heavily calcified. Clinical evaluations were assessed immediately post procedure and at 30-day follow-up. RESULTS Freedom from clinical perforation at the time of the procedure was achieved in 98.8% of patients. The device facilitated CTO crossing into the distal true lumen (technical success) in 68 (80.0%) patients, with subsequent distal guidewire positioning in 65 (76.5%). The average ABI (n=58) improved from 0.65 (range 0.35-1.20) at baseline to 1.00 (range 0.50-2.00) through 30-day follow-up. Symptoms improved in 70 (82.4%) patients upon treatment, and improvement was maintained in 57/70 (81.4%) through 30 days. CONCLUSION The ReOpen Study demonstrated that the TruePath device is safe and effective for facilitating crossing of CTOs resistant to conventional guidewire maneuvers.
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Patel Y, Depta JP, DeMartini TJ. Complications of chronic total occlusion percutaneous coronary intervention. Interv Cardiol 2013. [DOI: 10.2217/ica.13.48] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Wilson WM, Bagnall AJ, Spratt JC. In case of procedure failure: facilitating future success. Interv Cardiol 2013. [DOI: 10.2217/ica.13.54] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Reversed C-arm projection for reduction of focal skin radiation exposure: experimental analysis and first clinical experience. Cardiovasc Interv Ther 2013; 29:167-72. [PMID: 23996109 DOI: 10.1007/s12928-013-0206-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022]
Abstract
Radiodermatitis, predominantly over the right scapula, is a well-known complication of complex percutaneous coronary interventions (PCI). To reduce focal radiation exposure, we analyzed an inversed X-ray beam direction using a reversed C-arm position. On phantom experiment, we found that 130° right anterior oblique projection reduced skin dose over the right scapula by 98.2 % (P < 0.001) compared with conventional 50° left anterior oblique projection. A 73-year-old man with history of bypass surgery, multiple PCI and chronic radiodermatitis over the right scapula presented with recurrent chest pain. After successful PCI using the reversed C-arm projection, no aggravation of radiodermatitis was found.
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Journy N, Sinno-Tellier S, Maccia C, Le Tertre A, Pirard P, Pagès P, Eilstein D, Donadieu J, Bar O. Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures. Br J Radiol 2012; 85:433-42. [PMID: 22457404 PMCID: PMC3486680 DOI: 10.1259/bjr/30010948] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 01/20/2011] [Accepted: 01/31/2011] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The study aimed to characterise the factors related to the X-ray dose delivered to the patient's skin during interventional cardiology procedures. METHODS We studied 177 coronary angiographies (CAs) and/or percutaneous transluminal coronary angioplasties (PTCAs) carried out in a French clinic on the same radiography table. The clinical and therapeutic characteristics, and the technical parameters of the procedures, were collected. The dose area product (DAP) and the maximum skin dose (MSD) were measured by an ionisation chamber (Diamentor; Philips, Amsterdam, The Netherlands) and radiosensitive film (Gafchromic; International Specialty Products Advanced Materials Group, Wayne, NJ). Multivariate analyses were used to assess the effects of the factors of interest on dose. RESULTS The mean MSD and DAP were respectively 389 mGy and 65 Gy cm(-2) for CAs, and 916 mGy and 69 Gy cm(-2) for PTCAs. For 8% of the procedures, the MSD exceeded 2 Gy. Although a linear relationship between the MSD and the DAP was observed for CAs (r=0.93), a simple extrapolation of such a model to PTCAs would lead to an inadequate assessment of the risk, especially for the highest dose values. For PTCAs, the body mass index, the therapeutic complexity, the fluoroscopy time and the number of cine frames were independent explanatory factors of the MSD, whoever the practitioner was. Moreover, the effect of technical factors such as collimation, cinematography settings and X-ray tube orientations on the DAP was shown. CONCLUSION Optimising the technical options for interventional procedures and training staff on radiation protection might notably reduce the dose and ultimately avoid patient skin lesions.
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Affiliation(s)
- N Journy
- Institut de Veille Sanitaire, Saint-Maurice, France.
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Srimahachota S, Udayachalerm W, Kupharang T, Sukwijit K, Krisanachinda A, Rehani M. Radiation skin injury caused by percutaneous coronary intervention, report of 3 cases. Int J Cardiol 2011; 154:e31-3. [PMID: 21636147 DOI: 10.1016/j.ijcard.2011.05.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 05/13/2011] [Indexed: 11/16/2022]
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Werner GS, Hochadel M, Zeymer U, Kerber S, Schumacher B, Grube E, Hauptmann KE, Brueck M, Zahn R, Senges J. Contemporary success and complication rates of percutaneous coronary intervention for chronic total coronary occlusions: results from the ALKK quality control registry of 2006. EUROINTERVENTION 2011; 6:361-6. [PMID: 20884415 DOI: 10.4244/eijv6i3a60] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Despite successful prevention of lesion recurrence by drug-eluting stents (DES), and the advancement in procedural techniques in the treatment of chronic total coronary occlusions (CTO), the number of CTOs treated by percutaneous coronary intervention (PCI) is still low as compared to their prevalence. This study aims to assess the outcome of PCI for CTOs in a contemporary survey of PCI in interventional centres in Germany. METHODS AND RESULTS The basis of this analysis is the 2006 quality assessment database of PCI conducted by the ALKK (working group of cardiology centres). Thirty-five centres contributed to this database, representing about 10% of all interventional centres of Germany. From a total of 20,502 patients, 8,882 patients with stable angina were selected. Of these 674 patients (7.6%) underwent PCI for a CTO. Their procedural characteristics and the hospital outcome were compared with patients treated for non-occlusive lesions. As compared to non-occlusive lesions, less patients underwent ad hoc PCI for a CTO. The fluoroscopy time was almost double of that in non-occlusive lesions, and contrast usage was significantly higher. The success rate was 60.1% as compared to 97.3% (p<0.001). Severe intraprocedural and in-hospital complications were similar for CTO and non-CTO lesions. Almost all patients with a CTO received a stent; DES were used in 53.4%, which was higher than the rate in non-CTO lesions (38.9%; p<0.001). CONCLUSIONS Although the success rate for PCI in CTOs is still well below that in non-occlusive lesions, this procedure is safe, encouraging its wider application. The low rate of DES use did not reflect the evidence for DES in CTOs.
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E. Chambers C, A. Fetterly K, Holzer R, Paul Lin PJ, C. Blankenship J, Balter S, K. Laskey W. Radiation safety program for the cardiac catheterization laboratory. Catheter Cardiovasc Interv 2011; 77:546-56. [DOI: 10.1002/ccd.22867] [Citation(s) in RCA: 224] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 09/28/2010] [Accepted: 10/06/2010] [Indexed: 11/11/2022]
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Favero L, Penzo C, Nikas D, Pacchioni A, Pasquetto G, Saccà S, Reimers B. Cardiac and extracardiac complications during CTO interventions: prevention and management. Interv Cardiol 2010. [DOI: 10.2217/ica.10.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Rathore S, Hakeem A, Pauriah M, Roberts E, Beaumont A, Morris JL. A comparison of the transradial and the transfemoral approach in chronic total occlusion percutaneous coronary intervention. Catheter Cardiovasc Interv 2009; 73:883-7. [PMID: 19455660 DOI: 10.1002/ccd.21922] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sudhir Rathore
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
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Grantham JA, Marso SP, Spertus J, House J, Holmes DR, Rutherford BD. Chronic Total Occlusion Angioplasty in the United States. JACC Cardiovasc Interv 2009; 2:479-86. [PMID: 19539249 DOI: 10.1016/j.jcin.2009.02.008] [Citation(s) in RCA: 211] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 02/17/2009] [Accepted: 02/24/2009] [Indexed: 01/16/2023]
MESH Headings
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/economics
- Angioplasty, Balloon, Coronary/education
- Angioplasty, Balloon, Coronary/mortality
- Angioplasty, Balloon, Coronary/statistics & numerical data
- Chronic Disease
- Clinical Competence
- Coronary Occlusion/economics
- Coronary Occlusion/mortality
- Coronary Occlusion/physiopathology
- Coronary Occlusion/therapy
- Cost-Benefit Analysis
- Education, Medical, Graduate
- Health Care Costs
- Healthcare Disparities
- Humans
- Patient Selection
- Recovery of Function
- Risk Assessment
- Treatment Outcome
- United States
- Ventricular Function, Left
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Affiliation(s)
- J Aaron Grantham
- Saint Luke's Health System's Mid-America Heart Institute, University of Missouri Kansas City School of Medicine, Kansas City, MO 64111, USA.
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Suzuki S, Furui S, Matsumaru Y, Nobuyuki S, Ebara M, Abe T, Itoh D. Patient skin dose during neuroembolization by multiple-point measurement using a radiosensitive indicator. AJNR Am J Neuroradiol 2008; 29:1076-81. [PMID: 18388215 PMCID: PMC8118850 DOI: 10.3174/ajnr.a1045] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2007] [Accepted: 05/15/2008] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although neuroembolization has recently spread quickly, sufficient attention has not been focused on the associated radiation exposure. The purpose of this research was to evaluate the patient's entrance skin dose (ESD) during neuroembolizations in 6 institutions. MATERIALS AND METHODS This study was approved by all of the 6 institutional review boards, and all of the patients gave informed consent. This study included a total of 103 consecutive neuroembolizations in the 6 institutions. Patient ESDs during the procedures were evaluated by using caps that had 44 radiosensitive indicators adherent to the surface. The patient ESDs were calculated from the color difference of the indicators. To check for effects on the scalp, clinical follow-up was performed at 1-2 days, 2 weeks, and 3 months after the procedure. RESULTS The averages of total fluoroscopic time, total number of digital subtraction angiography frames, and dose area product were 67.1 +/- 41.6 minutes, 883 +/- 626, and 257 +/- 150 Gy x cm(2), respectively. The average maximum ESD for each patient was 1.9 +/- 1.1 Gy (range, 0.4-5.6 Gy; median, 1.5 Gy). The average maximum ESDs of each institution ranged from 1.0 to 2.4 Gy. Epilation was observed in 6 patients. CONCLUSIONS The maximum ESDs during neuroembolizations exceed the thresholds for radiation skin injuries in some cases.
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Affiliation(s)
- S Suzuki
- Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan.
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Suzuki S, Furui S, Isshiki T, Kozuma K, Koyama Y, Ochiai M, Asakura Y. Methods to reduce patients' maximum skin dose during percutaneous coronary intervention for chronic total occlusion. Catheter Cardiovasc Interv 2008; 71:792-8. [PMID: 18324699 DOI: 10.1002/ccd.21481] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The purpose of this research is to assess the patient's entrance skin dose (ESD) during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO), and discuss methods to reduce the maximum ESDs. BACKGROUND Only a few reports are available on the methods to reduce patients' maximum ESD during the procedures. METHODS This study included consecutive 30 patients who underwent PCI procedures for CTO in the three institutions. Pearson correlation test was employed to determine the relationship between total fluoroscopic time (TFT) and the maximum ESD, dose area product (DAP) value, and the maximum ESD in each institution. RESULTS There were significant correlations between the TFT and maximum ESD (Institution 1: P = 0.000410, Institution 2: P = 0.000525), and between the DAP and the maximum ESD (Institution 2: P < 0.0001). In Institution 1, TFT of 60 min was set as the upper limit, and the maximum ESDs were controlled within 7 Gy. In Institution 2, the angiographic unit was a biplane system, and two skin sites were exposed, corresponding to the angulation of each X-ray tube. In Institution 3, the interventionalist changed the beam angulations frequently by several degrees during the procedures, and the maximum ESD was controlled within 3 Gy even during procedures with a TFT of more than 1 hr. CONCLUSIONS The TFT and DAP, the latter of which is preferable, are useful to estimate the maximum ESD. Limiting the TFT or DAP, or changing the beam angulations is important to control ESD during prolonged procedures.
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Affiliation(s)
- Shigeru Suzuki
- Department of Radiology, Teikyo University School of Medicine, Kaga, Itabashi-ku, Tokyo, Japan.
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Suzuki S, Furui S, Isshiki T, Kozuma K, Koyama Y, Yamamoto H, Ochiai M, Asakura Y, Ikari Y. Patients' skin dose during percutaneous coronary intervention for chronic total occlusion. Catheter Cardiovasc Interv 2008; 71:160-4. [DOI: 10.1002/ccd.21284] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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