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Prevalence of high and very high radiation doses to patients during percutaneous coronary interventions
Abstracts / Annales de Cardiologie et d’Angéiologie 62 (2013) 372–381 Warfarin for hypersplenism. He’s hospitalized in ICU for ACS with troponin elevation. EKG showed a RBB and ST depression in inferolateral leads. Methods.– We performed the CA through left radial approach as usual for unique left mammary graft. We found a totaly occluded mid-LAD with a good patency of the LIMA graft; a long and calcified stenosis of LCX and first marginal branch. The SVG on this vessel was occluded. RCA was occluded at the proximal part. We then catheterized the coeliac tronk with a 125 cm long 5Fr multipurpose catheter to do a non-selective injection of the GE graft that we were able to canulate selectively over a 0.025 hydrophilic guidewire. The angiogram revealed a short and thight stenosis at the distal anastomosis of this graft. The distal bed was big and dominant and without signicant disease on the PDA and PLA branchs. A 300 cm long 0.014 BHW guidewire was advanced in the diagnostic catheter and through the lesion quite easily leaning in the PLA. Then we exchange the diagnostic catheter for a Cordis 5Fr XB4 guiding catheter over the 300 cm BHW. It was the very easy to predilate the lesion and implant a 2.75 by 13 mm bare metal stent. A high pressure post-dilatation was performed with a 3 mm diameter NC balloon. An excellent angiographic was obtained. Four days after an intensive medical therapy, we performed a complex intervention with rotational atherectomy and two drug eluting stents on the LCX and marginal through right radial approach. Conclusion.– Gastroepiploic graft PCI is feasible and safe through radial approach. Hyperselective canulation with conventional 5Fr guiding catheters can be used to facilitate the procedure. http://dx.doi.org/10.1016/j.ancard.2013.07.005
Prevalence of high and very high radiation doses to patients during percutaneous coronary interventions J.-L. Georges a,c , L. Belle b,c , L. Orion c , S. Elhadad c , X. Marcaggi c , F. Funck c , F. Vinchon c , C. Maccia a , B. Livarek a,c , N. Lucke c , T. Carrères c , J.-M. Montely c , F. Schaad c , O. Nugue c , J.-P. Faure c , F. Albert c , H. Faltot c , G. Karrillon c , P. Leddet c , P. Schiano c , A. Dibie c , L. Meunier c , J.-M. Perron c , X. Marchand c , F. Funck c , Y. Chalet c , L. Genet c , J.-B. Azowa a , S. Cattan c a Service de cardiologie, CH de Versailles, 78150 Le Chesnay, France b RENAU, CH d’Annecy, 74370 Pringy, France c Collège national des cardiologues des hôpitaux, 75000 Paris, France Background.– Interventional coronary procedures (ICP) are associated with high radiation doses to patient. A skin entrance dose of > 3 Grays (Gy), usually associated with an Air Kerma at reference point (Ka,r) of > 5 Gy, and a Dose-Area Product (DAP) of > 500 Gy.cm2 , is considered as a threshold for deterministic effects (radiodermatitis), and a potential trigger for clinical follow-up. Data from large populations concerning the prevalence of high levels of exposure during ICPs are lacking. Purpose.– The purpose of this nationwide, multicentre survey was to evaluate current practices for patient radiation protection (RP) in French non-university public hospitals, which represent > 30% of the national activity for ICP, and 60% of the emergency cases. Methods.– RP parameters from 31 066 coronary angiographies (CAs) and 25 356 percutaneous coronary interventions (PCIs) performed at 44 centres during 2010, routinely registered were extracted and retrospectively analyzed. Emergency and complex procedures, such as PCI for acute STEMI, chronic total coronary occlusion (CTO), or grafts lesions, were not excluded. Extreme values were validated and/or corrected by centres. DAP and Ka,r, more likely to reflect skin dose, were analyzed. Results.– The table shows the prevalence of CAs and PCIs delivering high radiations doses (DAP > 3-fold the Reference Levels [45 Gy.cm2 for CA, and 94 for PCI, respectively], and Ka,r > 3 Gy), and very high doses (DAP > 500 Gy.cm2 , and Ka,r > 5 Gy).
373
CAs
PCIs
All
Dose Area Product > X3 RL > 300 Gy.cm2 > 500 Gy.cm2
n = 31 066 553 (1.8%) 28 (0.1%) 1 (0.0%)
n = 25 356 369 (1.5%) 369 (1.5%) 49 (0.2%)
n = 56 422 922 (1.6%) 397 (0.7%) 50 (0.1%)
Total Air Kerma > 3 Gy > 5 Gy
n = 10 990 55 (0.5%) 10 (0.1%)
n = 8966 766 (8.5%) 210 (2.3%)
n = 19 956 821 (4.1%) 220 (1.1%)
Conclusion.– This multicentre survey showed that approximately 1–2% of patients undergoing PCI receive very high doses of X-rays that may cause deterministic effects. Maximal doses were delivered during PCIs for CTO. Optimization techniques should be generalized during PCI. http://dx.doi.org/10.1016/j.ancard.2013.07.006
Radial route is not associated with higher radiation doses to patient during percutaneous coronary interventions J.-L. Georges a,b , M. Hanssen b , J. Monsegu b , P. Goube b , B. Moquet b , T. Carreres b , S. Werquin b , A. Akesbi b , B. Jouve b , F. Duclos b , F. Soto b , J.-L. Hirsch b , C. Thuaire b , A. Luycx-Bore b , M. Ghannem b , P. Cazaux b , C. Caussin b , K. Khalife b , J. Ballout b , G. Rouhault b , P. Deutsch b , E. Colpart b , H. Benamer b , D. Vilarem b , E. Filippi-Codaccioni b , B. Livarek a,b , L. Belle b , S. Cattan b a Cardiology, CH de Versailles, 78150 Le Chesnay, France b Collège national des cardiologues des hôpitaux, 75000 Paris, France Background.– A large amount of literature suggests that coronary angiography (CA) and percutaneous coronary interventions (PCI) performed by radial route are associated with higher radiation doses to patient. RAY’ACT is a nationwide, multicentre, French survey aimed at evaluating current practices for patient radiation protection (RP) in French non-university public hospitals. Purpose.– The purpose of this study was to compare RP parameters during CAs and PCIs performed via radial and femoral routes. Methods.– RP parameters from 31 066/33 931 (91%) CAs and 25 356/27 823 (91%) PCIs performed at 44 centres during 2010, and routinely registered in professional software were retrospectively analyzed. Extreme values were validated and/or corrected by centres. Dose Area Product (DAP in Gy.cm2 ) and Fluoroscopy time (FT in min), presented as median [quartiles], were compared between procedures performed by radial and femoral routes. Arterial access was missing for 286 CAs and 359 PCIs. Results.– Radial route was used in 21 726/30 780 CAs (71%, range of centres 8%–93%) and in 17 134/24 997 PCIs (68%, range 6%–94%). Compared to femoral route, FT was higher in CAs and PCIs performed by radial route (3.5 min [2.1–6.5] vs 3.8 [2.3–6.3] for CA, and 10.1 min [6.2–16.7] vs 10.4 [6.9–16.0] for PCI, respectively, all P < 0.01). Conversely, DAP was lower in procedures performed by radial route (26.8 Gy.cm2 [15.1–44.5] vs 28.1 [16.4–46.9] by femoral route for CA, and 55.6 Gy.cm2 [32.1–92.1] vs 59.4 [34.6–99.9] for PCI, respectively, all P < 0.001). The difference in DAP remained significant (P < 0.01) after adjustment on age, sex, BMI, emergency procedure, left ventriculography. A significant interaction was found between DAP and the volume of the centre for radial route (P < 0.001). DAP was significantly higher by radial than by femoral route in centres with low volume for radial route (34.2 Gy.cm2 vs 26.6 for CA, 78.1 vs 76.1 for PCI; P < 0.01), and lower in high-volume centres (24.1 Gy.cm2 vs 25.3 for CA, 50.8 vs 54.2 for PCI; P < 0.01). Conclusion.– In this nationwide multicentre survey, radial route was used predominantly for CA and PCI, and was associated with lower radiation doses to patient than the femoral route. Radial route delivered higher radiation doses only in low-volume centres for radial route. http://dx.doi.org/10.1016/j.ancard.2013.07.007
Prevalence of high and very high radiation doses to patients during percutaneous coronary interventions J.-L. Georges a,c , L. Belle b,c , L. Orion c , S. Elhadad c , X. Marcaggi c , F. Funck c , F. Vinchon c , C. Maccia a , B. Livarek a,c , N. Lucke c , T. Carrères c , J.-M. Montely c , F. Schaad c , O. Nugue c , J.-P. Faure c , F. Albert c , H. Faltot c , G. Karrillon c , P. Leddet c , P. Schiano c , A. Dibie c , L. Meunier c , J.-M. Perron c , X. Marchand c , F. Funck c , Y. Chalet c , L. Genet c , J.-B. Azowa a , S. Cattan c a Service de cardiologie, CH de Versailles, 78150 Le Chesnay, France b RENAU, CH d’Annecy, 74370 Pringy, France c Collège national des cardiologues des hôpitaux, 75000 Paris, France Background.– Interventional coronary procedures (ICP) are associated with high radiation doses to patient. A skin entrance dose of > 3 Grays (Gy), usually associated with an Air Kerma at reference point (Ka,r) of > 5 Gy, and a Dose-Area Product (DAP) of > 500 Gy.cm2 , is considered as a threshold for deterministic effects (radiodermatitis), and a potential trigger for clinical follow-up. Data from large populations concerning the prevalence of high levels of exposure during ICPs are lacking. Purpose.– The purpose of this nationwide, multicentre survey was to evaluate current practices for patient radiation protection (RP) in French non-university public hospitals, which represent > 30% of the national activity for ICP, and 60% of the emergency cases. Methods.– RP parameters from 31 066 coronary angiographies (CAs) and 25 356 percutaneous coronary interventions (PCIs) performed at 44 centres during 2010, routinely registered were extracted and retrospectively analyzed. Emergency and complex procedures, such as PCI for acute STEMI, chronic total coronary occlusion (CTO), or grafts lesions, were not excluded. Extreme values were validated and/or corrected by centres. DAP and Ka,r, more likely to reflect skin dose, were analyzed. Results.– The table shows the prevalence of CAs and PCIs delivering high radiations doses (DAP > 3-fold the Reference Levels [45 Gy.cm2 for CA, and 94 for PCI, respectively], and Ka,r > 3 Gy), and very high doses (DAP > 500 Gy.cm2 , and Ka,r > 5 Gy).
373
CAs
PCIs
All
Dose Area Product > X3 RL > 300 Gy.cm2 > 500 Gy.cm2
n = 31 066 553 (1.8%) 28 (0.1%) 1 (0.0%)
n = 25 356 369 (1.5%) 369 (1.5%) 49 (0.2%)
n = 56 422 922 (1.6%) 397 (0.7%) 50 (0.1%)
Total Air Kerma > 3 Gy > 5 Gy
n = 10 990 55 (0.5%) 10 (0.1%)
n = 8966 766 (8.5%) 210 (2.3%)
n = 19 956 821 (4.1%) 220 (1.1%)
Conclusion.– This multicentre survey showed that approximately 1–2% of patients undergoing PCI receive very high doses of X-rays that may cause deterministic effects. Maximal doses were delivered during PCIs for CTO. Optimization techniques should be generalized during PCI. http://dx.doi.org/10.1016/j.ancard.2013.07.006
Radial route is not associated with higher radiation doses to patient during percutaneous coronary interventions J.-L. Georges a,b , M. Hanssen b , J. Monsegu b , P. Goube b , B. Moquet b , T. Carreres b , S. Werquin b , A. Akesbi b , B. Jouve b , F. Duclos b , F. Soto b , J.-L. Hirsch b , C. Thuaire b , A. Luycx-Bore b , M. Ghannem b , P. Cazaux b , C. Caussin b , K. Khalife b , J. Ballout b , G. Rouhault b , P. Deutsch b , E. Colpart b , H. Benamer b , D. Vilarem b , E. Filippi-Codaccioni b , B. Livarek a,b , L. Belle b , S. Cattan b a Cardiology, CH de Versailles, 78150 Le Chesnay, France b Collège national des cardiologues des hôpitaux, 75000 Paris, France Background.– A large amount of literature suggests that coronary angiography (CA) and percutaneous coronary interventions (PCI) performed by radial route are associated with higher radiation doses to patient. RAY’ACT is a nationwide, multicentre, French survey aimed at evaluating current practices for patient radiation protection (RP) in French non-university public hospitals. Purpose.– The purpose of this study was to compare RP parameters during CAs and PCIs performed via radial and femoral routes. Methods.– RP parameters from 31 066/33 931 (91%) CAs and 25 356/27 823 (91%) PCIs performed at 44 centres during 2010, and routinely registered in professional software were retrospectively analyzed. Extreme values were validated and/or corrected by centres. Dose Area Product (DAP in Gy.cm2 ) and Fluoroscopy time (FT in min), presented as median [quartiles], were compared between procedures performed by radial and femoral routes. Arterial access was missing for 286 CAs and 359 PCIs. Results.– Radial route was used in 21 726/30 780 CAs (71%, range of centres 8%–93%) and in 17 134/24 997 PCIs (68%, range 6%–94%). Compared to femoral route, FT was higher in CAs and PCIs performed by radial route (3.5 min [2.1–6.5] vs 3.8 [2.3–6.3] for CA, and 10.1 min [6.2–16.7] vs 10.4 [6.9–16.0] for PCI, respectively, all P < 0.01). Conversely, DAP was lower in procedures performed by radial route (26.8 Gy.cm2 [15.1–44.5] vs 28.1 [16.4–46.9] by femoral route for CA, and 55.6 Gy.cm2 [32.1–92.1] vs 59.4 [34.6–99.9] for PCI, respectively, all P < 0.001). The difference in DAP remained significant (P < 0.01) after adjustment on age, sex, BMI, emergency procedure, left ventriculography. A significant interaction was found between DAP and the volume of the centre for radial route (P < 0.001). DAP was significantly higher by radial than by femoral route in centres with low volume for radial route (34.2 Gy.cm2 vs 26.6 for CA, 78.1 vs 76.1 for PCI; P < 0.01), and lower in high-volume centres (24.1 Gy.cm2 vs 25.3 for CA, 50.8 vs 54.2 for PCI; P < 0.01). Conclusion.– In this nationwide multicentre survey, radial route was used predominantly for CA and PCI, and was associated with lower radiation doses to patient than the femoral route. Radial route delivered higher radiation doses only in low-volume centres for radial route. http://dx.doi.org/10.1016/j.ancard.2013.07.007