Modulated radiation protocol achieves marked reduction of radiation exposure for chronic total coronary occlusion intervention. Issue 6 (15th July 2020)

• Record Type: Journal Article
• Authors: Werner, Gerald S.; Yaginuma, Kenji; Koch, Matthias; Tischer, Karlheinz; Silber, Martin; Werner, Juliane; Keuser, Thomas; Moehlis, Hiller
• Is Part Of: Catheterization and cardiovascular interventions. Volume 97:Issue 6(2021)
• Page Start: 1196
• Page End: 1206
• Publication Date: 2020-07-15
• Subjects: chronic total coronary occlusion -- percutaneous coronary intervention -- radiation exposure; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.29132
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Objective: To evaluate the feasibility of a new acquisition protocol to reduce radiation exposure. Background: Percutaneous coronary interventions (PCI) for chronic total coronary occlusions (CTO) are characterized by the highest radiation exposure among PCI procedures. Methods: We analyzed 552 consecutive CTO procedures between January 2018 and October 2019. After 366 procedures (Group 1) a modified radiation acquisition protocol was implemented for the subsequent 186 procedures (Group 2). Besides a low fluoroscopy frame rate of 6/s and cine frame rate of 7.5/s for both groups, additional modifications consisted of increased copper filtering with lower entry dose in combination with a modified image postprocessing. Radiation exposure was assessed as air kerma (AK; mGy), and dose–area product (DAP; cGy*cm 2 ). Results: There was no significant difference in lesion or procedural complexity between the study groups with 46 and 43% of the procedures done via the retrograde approach. While fluoroscopy time remained similar (median: 32.7 vs. 34.3 min), the protocol modifications resulted in a drastic reduction of AK by 68% from 2, 040 (1, 321–3, 339) mGy to 655 (415–1, 113) mGy ( p < .001) without affecting the procedural success rate. DAP was equally decreased by 71%. These considerable reductions were observed even in obese patients of BMI > 30. In Group 2, not a single procedure exceeded the 5 Gy threshold as compared to 10.4% in Group 1. Conclusions: Radiation exposure decreased considerably with a new acquisition protocol without affecting procedure duration and success. These modifications were applicable also to patients with a high BMI.