scholarly journals Occupational radiation exposure in femoral artery approach is higher than radial artery approach during coronary angiography or percutaneous coronary intervention

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Jung-Su Kim ◽  
Bong-Ki Lee ◽  
Dong-Ryeol Ryu ◽  
Kwangjin Chun ◽  
Ho-Seok Kwon ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Radiation Exposure ◽  
Radial Artery ◽  
Femoral Artery ◽  
Coronary Intervention ◽  
Occupational Radiation Exposure ◽  
Percutaneous Coronary ◽  
Occupational Radiation

scholarly journals Radial artery access for coronary angiography and percutaneous coronary intervention

BMJ ◽  
2004 ◽  
Vol 329 (7463) ◽  
pp. 443-446 ◽  
Author(s):  
R Andrew Archbold ◽  
Nicholas M Robinson ◽  
Richard J Schilling
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Radial Artery ◽  
Coronary Intervention ◽  
Percutaneous Coronary

Haematoma after Coronary Angiography and Percutaneous Coronary Intervention via the Femoral Artery Frequency and Risk Factors

2005 ◽  
Vol 4 (2) ◽  
pp. 123-127 ◽  
Author(s):  
Kirsten Andersen ◽  
Marianne Bregendahl ◽  
Helen Kaestel ◽  
Mette Skriver ◽  
Jan Ravkilde
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Femoral Artery ◽  
Multivariate Logistic Regression Analysis ◽  
Coronary Intervention ◽  
Low Molecular Weight ◽  
Multivariate Logistic Regression ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Made In

Background: The most common complication after coronary angiography (CA) and percutaneous coronary intervention (PCI) is the development of haematoma. Several changes in procedures regarding CA and PCI have been made in our department in recent years. The aim of this audit is to establish how many patients develop haematoma after CA/PCI via the femoral artery and subsequently to find predictors that increase the risk of developing haematoma. Methods: We initially included 474 consecutive patients-322 patients undergoing CA and 141 patients undergoing PCI. Eleven patients were later excluded due to the absence of complete data. Thirty-three variables were registered in order to find predictors, which might increase the haematoma frequency. A univariate as well as a multivariate logistic regression analysis was performed. Results: Of the 463 patients, 6 patients developed a haematoma > 10 cm (1.3%) and 41 patients developed a haematoma > 5 cm (8.9%). The following factors were found to be associated with the generation of haematoma: Women, systolic blood pressure > 160 mm Hg, artery puncture > 1, sheath time > 16 min, ACT ≥ 175 s, Glycoprotein (GP) IIB/IIIa inhibitors, Low Molecular Weight Heparin before procedure, personnel change during compression, and anti-coagulant-treatment before procedure. Conclusions: The frequency of haematoma was 1.3% (> 10 cm) and 8.9% (> 5 cm), which corresponds with reports from similar studies and departments. The factors found to increase the risk of haematoma development can provide background for procedural changes and increase the focus on patients at increased risk in order to minimize the development of haematomas.

Abstract 188: Implementation of Choosing Wisely Recommendations for Stress-First Nuclear Myocardial Perfusion Imaging

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
David E Winchester ◽  
Randy Jeffrey ◽  
Carsten Schmalfuss ◽  
David C Wymer ◽  
Vicente Taasan ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Myocardial Perfusion Imaging ◽  
Radiation Dose ◽  
Coronary Angiography ◽  
Myocardial Perfusion ◽  
Radiation Exposure ◽  
Perfusion Imaging ◽  
Coronary Intervention ◽  
Imaging Protocol ◽  
Percutaneous Coronary

Introduction: Current guidelines for myocardial perfusion imaging (MPI) encourage facilities to adopt patient-centered risk mitigation strategies such as individualized radiotracer dosing and stress-first imaging. Reducing radiation exposure is also a key recommendation of multiple societies participating in the Choosing Wisely campaign. The stated goal is for over 50% of studies to be performed with <9 millisieverts (mSv) of radiation exposure. We hypothesized that adoption of a stress-first/stress-only imaging protocol would substantially reduce the median radiation dose administered in our nuclear lab. Methods: We switched the standard imaging protocol at the Malcom Randall VA Medical Center nuclear cardiology laboratory from rest-stress to stress-rest. To achieve this, a physician was required to review the stress images at the time they were obtained to determine if further imaging was indicated. Estimated effective radiation doses (in mSv) were calculated based on the radiotracer activity administered (in millicuries) used industry standards techniques. We compared 2 cohorts of patients: rest-stress studies consecutively done between 7/17/17 and 11/12/17 and stress-first studies consecutively done between 11/13/17 and 5/17/17. As a balancing measure, we compared the rate of normal studies between the cohorts. A normal MPI was defined as no evidence of ischemia or infarction with a preserved ejection fraction. Results: In the stress-first cohort, the median dose was 2.8 millisieverts (mSv) compared with 14.1 mSv in the rest-stress cohort (80.1% reduction, p<0.0001). During the observed period, we estimate that 4,780 mSv of effective dose were avoided. In the rest-stress cohort, 424 studies were performed. In the stress-first cohort, 716 tests were performed, 423 stress only studies (59.1%) and 293 stress-rest studies (40.1%). The rate of normal studies in the stress-first cohort was not different from the rest-stress cohort (stress-first: 73.5%, (526/716) versus rest-stress: 71.7%, p=0.54, odds ratio 0.92, 95% CI 0.69-1.21) In the rest-stress cohort, 3 patients (1.0%) underwent coronary angiography and 2 patients (0.7%) underwent percutaneous coronary intervention (PCI). In the stress-first cohort 8 patients (1.1%) underwent coronary angiography and 2 patient (0.3%) underwent percutaneous coronary intervention (PCI). Conclusion: By switching from a rest-stress to a stress-first imaging protocol, we reduced the median radiation dose in our lab by 80%. We observed no change in the proportion of normal tests, suggesting no potential for harm with this strategy.

Comparison of Clinical Value between Right Distal Radial Artery Access and Right Radial Artery Access in Patients Undergoing Coronary Angiography or Percutaneous Coronary Intervention

2020 ◽  
Author(s):  
Jianhua Fan
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Radial Artery ◽  
Coronary Intervention ◽  
Access Time ◽  
Arterial Access ◽  
Compression Time ◽  
Percutaneous Coronary ◽  
The Right ◽  
Distal Radial Artery

Objective: To compare the feasibility and safety between right distal radial artery access and right radial artery accessin patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI).Methods: On the basis of arterial access, 113 patients who underwent CAG or PCI in Kunshan Hospital of TraditionalChinese Medicine between January and October 2018 were divided into two groups: a right distal radial artery group (52 patients) and a right radial artery group (61 patients). We collected general information, the number of puncture attempts, access times, postoperative compression time, and complications.Results: The general characteristics, rate of successful radial artery puncture, and rate of successful catheter placement inthe two groups were not different. The right radial artery group had fewer puncture attempts (1.26 ± 0.44 times vs. 2.19 ± 0.53times, P = 0.001) and a shorter access time (3.23 ± 0.86 min vs. 4.77 ± 1.49 min, P = 0.001) than the right distal radial arterygroup. However, the postoperative compression time in the right distal radial artery group was shorter (3.44 ± 0.9 h vs.7.16 ± 1.21 h, P = 0.001). Two cases of bleeding, four cases of hematoma, and one case of artery occlusion in the right radialartery group and one case of hematoma in the right distal artery group occurred before discharge. The rate of total complicationsin the right distal radial artery group was lower than in the right radial artery group (1.93% vs. 11.48%, P = 0.048).Conclusion: CAG or PCI through the right distal radial artery is feasible and safe.

scholarly journals Feasibility and Safety of Distal Radial Artery Access in Anatomical Snuffbox for Coronary Angiography and Coronary Intervention

2020 ◽  
Vol 18 (2) ◽  
pp. 259-262
Author(s):  
Arun Maskey ◽  
Birat Krishna Timalsena ◽  
Sheikh Aslam ◽  
Rabindra Pandey ◽  
Madhu Roka ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Radial Artery ◽  
Vascular Access ◽  
Coronary Intervention ◽  
Pain Rating ◽  
Coronary Interventions ◽  
Transradial Access ◽  
Percutaneous Coronary ◽  
Distal Radial Artery

Background: There is limited data on feasibility and safety of coronary interventions performed using radial artery at anatomical snuffbox as vascular access point in South Asian region. Our study attempts to evaluate the feasibility and safety of coronary angiography and percutaneous coronary intervention using transradial access at anatomical snuffbox.Methods: Transradial access at anatomical snuffbox was attempted in 128 consecutive patients, who were planned for coronary angiography and/or percutaneous coronary intervention. Success in vascular access, completion of planned procedure and complications encountered, including patency of radial artery after the procedure, were investigated. Results: A total of 128 patients (76 males [59.4%]; 52 females [40.6%]) between 44-78 years of age (mean age, 59.0 +/- 10.2 years) were included in the study. Distal radial artery puncture and sheath placement was successful in all patients however planned procedure was completed in 126 (98.4%) patients. Total 90 coronary angiographies and 36 percutaneous coronary interventions were performed of which five were primary percutaneous coronary intervention. We encountered brachial artery spasm among two patient (1.5%) and significant pain and swelling among three patients (2.3%). No bleeding complication, numbness or parasthesia were observed on follow-up. Patients had average pain rating of 2.4+/- 1.1 in visual analogue pain rating scale. There were no instances of radial artery occlusion after the procedure.Conclusions: Distal radial artery, at anatomical snuffbox, is a safe and feasible alternative vascular access site for coronary angiography and percutaneous coronary intervention. Keywords: Cardiac catheter; coronary angiography; feasibility studies; percutaneous coronary intervention; radial artery; vascular access device

scholarly journals Impact of trainee involvement on patient radiation exposure and contrast volumes during invasive cardiac procedures

2020 ◽  
Vol 43 (1) ◽  
pp. E18-E21
Author(s):  
Vinay Kansal ◽  
Trevor Simard ◽  
Pietro Di Santo ◽  
Aun Yeong Chong ◽  
Derek So ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Radiation Exposure ◽  
Coronary Intervention ◽  
Contrast Administration ◽  
Cardiac Procedures ◽  
Primary Operator ◽  
Percutaneous Coronary ◽  
Patient Radiation Exposure ◽  
Diagnostic Coronary Angiography

Purpose: The impact of cardiology fellows (CFs) and interventional cardiology fellows (ICFs) on patient radiation and contrast exposure during diagnostic coronary angiography and percutaneous coronary intervention is unknown. Methods: Between 2011 and 2014, 16,175 cases were retrospectively assessed involving 27 CFs, 22 ICFs and 24 staff as primary operators. Results: During diagnostic coronary angiography, ICFs administered the lowest radiation dose (5,648±5,523 cGy*cm2; 1.30 ± 1.27 mSv)—achieving 22% less radiation than the staff (6,889±4,294 cGy*cm2; 1.58 ± 0.99 mSv) and 36% less than CFs (7,700±6,751 cGy*cm2; 1.77 ± 1.55 mSv) (p<0.01). When adjusted for access site, CFs administered more radiation than either the ICFs or staff. However, differences between ICFs and staff were exclusively observed during transradial procedures (p<0.01). With regards to contrast administration, ICFs administered less contrast (126.3 ± 57.6 mL) than either CFs (130±52.4 mL) or staff (132.7±47.6 mL) (p<0.01)—again, a finding isolated to the transradial cohort. Of the 6,751 percutaneous coronary intervention cases, no significant differences existed between the ICFs or staff cardiologists in patient radiation exposure—but a CF as the primary operator resulted in an 18% increase in radiation exposure. Notably, contrast use was not different amongst the types of operators (p<0.05). Conclusion: In conclusion, having a cardiology fellow as primary operator during invasive cardiac procedures increases patient radiation exposure and minimally increases contrast administration. Strategies to minimize patient radiation exposure while maintaining trainee involvement should be evaluated.

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