Patient exposure dose in interventional cardiology per clinical and technical complexity levels. Part 1: results of the VERIDIC project

2021 ◽  
pp. 028418512110614
Author(s):  
Joelle Ann Feghali ◽  
Julie Delépierre ◽  
Olivera Ciraj Belac ◽  
Jérémie Dabin ◽  
Marine Deleu ◽  
...  
Keyword(s):  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Exposure Dose ◽  
Skin Dose ◽  
Clinical Parameters ◽  
Patient Exposure ◽  
Total Occlusion ◽  
Technical Parameters ◽  
Clinical Complexity ◽  
Stent Length

Background Patients can be exposed to high skin doses during complex interventional cardiology (IC) procedures. Purpose To identify which clinical and technical parameters affect patient exposure and peak skin dose (PSD) and to establish dose reference levels (DRL) per clinical complexity level in IC procedures. Material and Methods Validation and Estimation of Radiation skin Dose in Interventional Cardiology (VERIDIC) project analyzed prospectively collected patient data from eight European countries and 12 hospitals where percutaneous coronary intervention (PCI), chronic total occlusion PCI (CTO), and transcatheter aortic valve implantation (TAVI) procedures were performed. A total of 62 clinical complexity parameters and 31 technical parameters were collected, univariate regressions were performed to identify those parameters affecting patient exposure and define DRL accordingly. Results Patient exposure as well as clinical and technical parameters were collected for a total of 534 PCI, 219 CTO, and 209 TAVI. For PCI procedures, body mass index (BMI), number of stents ≥2, and total stent length >28 mm were the most prominent clinical parameters, which increased the PSD value. For CTO, these were total stent length >57 mm, BMI, and previous anterograde or retrograde technique that failed in the same session. For TAVI, these were male sex, BMI, and number of diseased vessels. DRL values for Kerma-area product ( PKA), air kerma at patient entrance reference point ( Ka,r), fluoroscopy time (FT), and PSD were stratified, respectively, for 14 clinical parameters in PCI, 10 in CTO, and four in TAVI. Conclusion Prior knowledge of the key factors influencing the PSD will help optimize patient radiation protection in IC.

scholarly journals Evidence for Benefit of Percutaneous Coronary Intervention for Chronically Occluded Coronary Arteries (CTO) – Clinical and Health Economic Outcomes

2014 ◽  
Vol 9 (3) ◽  
pp. 190 ◽  
Author(s):  
John Rawlins ◽  
James Wilkinson ◽  
Nick Curzen ◽  
◽  
◽  
...  
Keyword(s):  
Chronic Total Occlusion ◽  
Significant Risk ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Limited Data ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
Technical Advances ◽  
Procedural Time ◽  
Safety Benefit

Percutaneous revascularisation of a coronary chronic total occlusion (CTO) remains one of the technical frontiers of interventional cardiology. CTOs are common, and yet intervention is only attempted in 10 % of cases. CTO procedures are perceived to be technically challenging, lengthy, associated with significant risk and have only limited data to support the practise. Recent technical advances have dramatically increased the success rate, shortened procedural time and improved clinical outcomes. The aim of this article is to critically examine the data that supports CTO intervention, including specifically an appraisal of procedural safety, benefit and overall cost effectiveness.

scholarly journals Percutaneous Coronary Intervention in Chronic Total Occlusion - In Hospital Outcome

1970 ◽  
Vol 1 (2) ◽  
pp. 156-160
Author(s):  
N Kar ◽  
M Ullah ◽  
PK Karmakar ◽  
AEM Mazharul Islam ◽  
AQM Reza ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Chronic Stable Angina ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Hospital Outcome ◽  
Number Of Patients ◽  
Percutaneous Coronary ◽  
Cardiac Catheterizations

Background- Although a total coronary occlusion is identified approximately in one third of the diagnostic cardiac catheterizations, still an attempted revascularization of total occlusion accounts for less than 8% of all percutaneous coronary interventions (PCI). Percutaneous Coronary Intervention (PCI) of chronic total occlusion (CTO) is one of the major challenges in interventional cardiology. It is now an well-accepted revascularization procedure.  Methods: It was a prospective observational study conducted in National Institute of Cardiovascular Diseases, Dhaka, from July 2004 to June 2005. 50 consecutive patients with chronic total occlusion undergoing PCI were included in the study. Patients were observed during procedure and during the hospital stay. Result: The mean age of the patients was 46.7 ± 9.3 and 48.0% were in the age range of 45-54 years. 24 patients had post MI angina, 20 patients had chronic stable angina and 6 patients had unstable angina. Technical success was in 98% cases and procedural success was in 94% cases. One patient developed vessel perforation and was treated by prolonged balloon inflation. There was no death or STEMI and only 2 patients developed NSTEMI. Conclusion: In our study with the use of available facilities PCI in CTOs was possible with a high success rate. But dealing of more complicated lesion will require more improved technology and hardware. A study with larger number of patients and longer duration of follow up to determine the efficacy of the procedure in improving morbidity and mortality is needed. Keywords : Chronic total occlusion; Percutaneous Coronary Intervention; In hospital outcome DOI: http://dx.doi.org/10.3329/cardio.v1i2.8122 Cardiovasc. j. 2009; 1(2) : 156-160

Establishing a priori and a posteriori predictive models to assess patients’ peak skin dose in interventional cardiology. Part 2: results of the VERIDIC project

2021 ◽  
pp. 028418512110620
Author(s):  
Joelle Ann Feghali ◽  
Julie Delépierre ◽  
Olivera Ciraj Belac ◽  
Jérémie Dabin ◽  
Marine Deleu ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Predictive Models ◽  
A Priori ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Skin Dose ◽  
A Posteriori ◽  
Tube Voltage ◽  
Percutaneous Coronary ◽  
Peak Skin Dose

Background Optimizing patient exposure in interventional cardiology is key to avoid skin injuries. Purpose To establish predictive models of peak skin dose (PSD) during percutaneous coronary intervention (PCI), chronic total occlusion percutaneous coronary intervention (CTO), and transcatheter aortic valve implantation (TAVI) procedures. Material and Methods A total of 534 PCI, 219 CTO, and 209 TAVI were collected from 12 hospitals in eight European countries. Independent associations between PSD and clinical and technical dose determinants were examined for those procedures using multivariate statistical analysis. A priori and a posteriori predictive models were built using stepwise multiple linear regressions. A fourfold cross-validation was performed, and models’ performance was evaluated using the root mean square error (RMSE), mean absolute percentage error (MAPE), coefficient of determination (R²), and linear correlation coefficient (r). Results Multivariate analysis proved technical parameters to overweight clinical complexity indices with PSD mainly affected by fluoroscopy time, tube voltage, tube current, distance to detector, and tube angulation for PCI. For CTO, these were body mass index, tube voltage, and fluoroscopy contribution. For TAVI, these parameters were sex, fluoroscopy time, tube voltage, and cine acquisitions. When benchmarking the predictive models, the correlation coefficients were r = 0.45 for the a priori model and r = 0.89 for the a posteriori model for PCI. These were 0.44 and 0.67, respectively, for the CTO a priori and a posteriori models, and 0.58 and 0.74, respectively, for the TAVI a priori and a posteriori models. Conclusion A priori predictive models can help operators estimate the PSD before performing the intervention while a posteriori models are more accurate estimates and can be useful in the absence of skin dose mapping solutions

scholarly journals Survey of Exposure Dose during Percutaneous Coronary Intervention for Chronic Total Occlusion

2017 ◽  
Vol 73 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Tomokazu Sakano ◽  
Tatsushi Iwamoto ◽  
Takuya Kuribara ◽  
Hajime Sakamoto ◽  
Osamu Tajima ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Exposure Dose ◽  
Total Occlusion ◽  
Percutaneous Coronary

scholarly journals Determinants of Greater Peak radiation skin dose in percutaneous coronary intervention for chronic total occlusion

2020 ◽  
Vol 76 (2) ◽  
pp. 217-223 ◽  
Author(s):  
Kei Yamamoto ◽  
Kenichi Sakakura ◽  
Kohei Hamamoto ◽  
Hiroko Hasegawa ◽  
Takunori Tsukui ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Skin Dose ◽  
Total Occlusion ◽  
Percutaneous Coronary

scholarly journals Factors Affecting the Patient's Skin Dose During Percutaneous Coronary Intervention for Chronic Total Occlusion

2007 ◽  
Vol 71 (2) ◽  
pp. 229-233 ◽  
Author(s):  
Shigeru Suzuki ◽  
Shigeru Furui ◽  
Takaaki Isshiki ◽  
Ken Kozuma ◽  
Goro Endo ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Skin Dose ◽  
Total Occlusion ◽  
Factors Affecting ◽  
Percutaneous Coronary

scholarly journals Complex Recanalization of Chronic Total Occluison Supported by Minimal Extracorporeal Circulation in a Patient with an Aortic Valve Bioprothesis in Extraanatomic Position

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Ruben Jansen ◽  
Brigitte Bathgate ◽  
Alexander Bufe ◽  
Jan-Erik Guelker
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Extracorporeal Circulation ◽  
Interventional Cardiology ◽  
Coronary Intervention ◽  
Circulatory Support ◽  
Circulation System ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
The Right

Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) still remains a major challenge in interventional cardiology. This case describes a complex PCI of the left main coronary artery and of a CTO of the right coronary artery using a minimal extracorporeal circulation system (MECC) in a patient with an aortic valve bioprothesis in extraanatomic position. It illustrates that complex recanalization strategies can be solved combining it with mechanical circulatory support technologies.

5964Hybrid PET/MR imaging for the prediction of left ventricular (LV) recovery after revascularisation of chronic total occluded coronaries

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Vitadello ◽  
C Rischpler ◽  
N Langwieser ◽  
K Kunze ◽  
S Nekolla ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Fdg Pet ◽  
Wall Motion Abnormality ◽  
Wall Motion ◽  
Imaging Techniques ◽  
Interventional Cardiology ◽  
Regional Wall Motion ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Total Occlusion

Abstract Background Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents one of the major challenges in interventional cardiology. Physicians are still reluctant in referring for PCI, assuming non viability of the myocardium subtended by the CTO. Data are controversial in assessing the improvement of left ventricular (LV) wall motion after revascularisation and the prognostic value of viability testing to guide patient selection. Purpose The aim of this study was to determine, whether hybrid fluorodeoxyglucose positron emission tomography/magnetic resonance (FDG PET/MR) imaging allows a more accurate prediction of LV regional wall motion recovery after successful PCI of CTOs in comparison to PET or MR alone. Methods We enrolled 49 consecutive symptomatic patients with CTO and evidence of wall motion abnormality in the corresponding CTO-territory. All patients underwent hybrid FDG PET/MR imaging as semi-quantitative assessment of myocardial viability - glucose metabolism in PET and late gadolinium enhancement (LGE) transmurality in MR – prior of PCI of the CTO. Follow-up MRI was performed in 23 patients 3–6 months after successful revascularisation to evaluate wall motion changes. Results We assessed viability in 124 myocardial segments subtended by a CTO in 23 patients with successful PCI who underwent serial imaging. Segments with wall motion abnormality at baseline (n=80) were analysed. Most of these segments (n=54, 68%) were concordantly assessed viable by PET and MR, conversely only 2 (2%) segments were assessed non-viable by both imaging techniques. However, almost one third of the segments showed discordant patterns of viability either PET not viable/ MR viable (3 (4%) segments) or PET viable/ MR not viable (21 (26%) segments): particularly the latter revealed a significant wall motion improvement (p=0.033). The combination of PET and MR showed a fair accuracy in predicting myocardial segments with wall motion improvement after CTO revascularisation (PET/MR area under ROC curve (AUC) 0.72, SE 0.07, p=0.002), which was superior to MR-LGE (AUC=0.66, SE 0.09) and FDG-PET (AUC=0.58, SE 0.10) alone (Figure). Comparisons of ROC curves Conclusion Hybrid PET/MR imaging prior to successful CTO showed a better performance than PET or MR alone in predicting regional improvement of disturbed wall motion. The complimentary information derived from both modalities may particularly help to identify small amounts of viable epicardial myocardium within large scars which can improve contractility after CTO-revascularisation.

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