scholarly journals Radiation Exposure Reduction and Patient Outcome by Using Very Low Frame Rate Fluoroscopy Protocol (3.8 + 7.5 fps) During Percutaneous Coronary Intervention

2021 ◽  
Vol 8 ◽  
Author(s):  
Ankush Gupta ◽  
Sanya Chhikara ◽  
Rajesh Vijayvergiya ◽  
Parag Barwad ◽  
Krishna Prasad ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Radiation Exposure ◽  
Retrospective Cohort ◽  
Coronary Intervention ◽  
Frame Rate ◽  
Cardiac Events ◽  
Air Kerma ◽  
Guide Catheter ◽  
Percutaneous Coronary ◽  
Low Frame Rate

Objectives: In this study, we intend to analyze the feasibility and efficacy of very low frame rate fluoroscopy (VLFF) protocol using a combination of 3.8 and 7.5 fps while performing Percutaneous Coronary Intervention (PCI).Methods: A retrospective cohort including 193 patients undergoing PCI under the VLFF protocol (Post-VLFF group) was compared with a retrospective cohort of 133 patients, who underwent PCI prior to implementation of VLFF protocol (Pre-VLFF group). In the Pre-VLFF group, all PCIs were performed using fluoroscopy frame rate of 15 fps. In the Post-VLFF group, 3.8 fps was used to guide catheter engagement, coronary lesion wiring, pre-and post-dilation, and 7.5 fps was used for lesion assessment and stent placement. Increasing use of fluoroscopic storage in place of cineangiography was also encouraged. Cine acquisition in both groups was performed at 15 fps. Primary endpoint was radiation exposure measured by Air Kerma. Secondary endpoints were procedure related outcomes and patient related outcomes (Major Adverse Cardiac Events including all-cause mortality, Target Lesion Failure, Myocardial Infarction, and Stroke).RESULTS: Post-VLFF group showed 74.7% reduction in Air Kerma as compared to Pre-VLFF group (433 ± 27 mGy vs. 1,714 ± 140 mGy; p < 0.0001), with no increase in the fluoroscopy time (15.38 ± 0.98 min Post-VLFF vs. 17.06 ± 1.29 min Pre-VLFF; p = 0.529) and contrast volume (116.5 ± 4.9 ml Post-VLFF vs. 116.7 ± 6 ml Pre-VLFF; p = 0.700). Both groups had comparable procedural success and complications rates as well as incidence of MACE.Conclusions: The very low frame rate fluoroscopy protocol is a feasible, effective, and safe method to significantly reduce the radiation exposure during PCI without any compromise on procedural and patient outcomes.

scholarly journals Radiation Reduction and Protection for Radiosensitive Organs (Lens, Thyroid, and Genital Organs) of Patients Receiving Percutaneous Coronary Intervention—Real-World Measurement of Radiation Dose in a Single Center

2021 ◽  
Vol 8 (8) ◽  
pp. 99
Author(s):  
Wen-Hwa Wang ◽  
Kai-Che Wei ◽  
Wei-Chun Huang ◽  
Yuan-Yin Yen ◽  
Guang-Yuan Mar
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Radiation Dose ◽  
Radiation Exposure ◽  
Radiation Protection ◽  
Coronary Intervention ◽  
Frame Rate ◽  
Protective Equipment ◽  
Radiation Doses ◽  
Percutaneous Coronary ◽  
Radiosensitive Organs

Backgrounds: Reducing radiation exposure is the basic principle for performing percutaneous coronary intervention (PCI). Many studies have confirmed the effect of radiation protection for medical staff, but studies about the effectiveness of protection for patients and real measurement of radiation dose in patients’ specific organs are lacking. Aim: To measure the radiation doses absorbed by patients’ radiosensitive organs during PCI and the effectiveness of radiation protection. Methods: A total of 120 patients were included and allocated into three groups as the ratio of 1:1:2. A total of 30 patients received PCI at 15 frames rate per second (fps), 30 patients at 7.5 fps, and 60 patients wore radiation protective hat and glasses during PCI at 7.5 fps. The radiation doses were measured at right eyebrow (lens), neck (thyroid), back (skin), and inguinal area (genital organs) by using thermoluminescent dosimeters (TLDs). Results: Dose-area product (DAP) reduced by 58.8% (from 534,454 ± 344,660 to 220,352 ± 164,101 mGy·cm2, p < 0.001) after reducing the frame rate, without affecting successful rate of PCI. Radiation doses measured on skin, lens, genital organs, and thyroid decreased by 73.3%, 40.0%, 40.0%, and 35.3%, respectively (from 192.58 ± 349.45 to 51.10 ± 59.21; 5.29 ± 4.27 to 3.16 ± 2.73; 0.25 ± 0.15 to 0.15 ± 0.15; and 17.42 ± 12.11 to 11.27 ± 8.52 μSv, p < 0.05). By providing radiation protective equipment, radiation doses at lens and thyroid decreased further by 71.8% and 65.9% (from 3.16 ± 2.73 to 0.89 ± 0.79; 11.27 ± 8.52 to 3.84 ± 3.49 μSv, p < 0.05). Conclusions: By lowering the frame rate and providing protective equipment, radiation exposure in radiosensitive organs can be effectively reduced in patients.

scholarly journals Contemporary approaches to bifurcation stenting

2021 ◽  
Vol 10 ◽  
pp. 204800402199219
Author(s):  
Claire E Raphael ◽  
Peter D O’Kane
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Stent Design ◽  
Cardiac Events ◽  
Balloon Inflation ◽  
Intracoronary Imaging ◽  
Percutaneous Coronary ◽  
Bifurcation Stenting ◽  
Bifurcation Lesions ◽  
Provisional Stenting

Bifurcation lesions are common and associated with higher risks of major cardiac events and restenosis after percutaneous coronary intervention (PCI). Treatment requires understanding of lesion characteristics, stent design and therapeutic options. We review the evidence for provisional vs 2-stent techniques. We conclude that provisional stenting is suitable for most bifurcation lesions. We detail situations where a 2-stent technique should be considered and the steps for performing each of the 2-step techniques. We review the importance of lesion preparation, intracoronary imaging, proximal optimization (POT) and kissing balloon inflation

scholarly journals Retrospective cohort analysis of Spanish national trends of coronary artery bypass grafting and percutaneous coronary intervention from 1998 to 2017

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e046141
Author(s):  
Manuel Carnero Alcazar ◽  
Daniel Hernandez-Vaquero ◽  
Hector Cubero-Gallego ◽  
Jose Lopez Menendez ◽  
Miguel Piñon ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Hospital Mortality ◽  
Retrospective Cohort ◽  
Artery Bypass ◽  
National Health System ◽  
Coronary Intervention ◽  
Bypass Grafting ◽  
Percutaneous Coronary

IntroductionSpain is one of the countries with the lowest rates of revascularisation and highest ratio of percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG).ObjectivesTo investigate the changes and trends in the two revascularisation procedures between 1998 and 2017 in Spain.DesignRetrospective cohort study. Analysis of in-hospital outcomes.SettingMinimum basic data set from the Spanish National Department of Health: mandatory database collecting information of patients who are attended in the Spanish public National Health System.Participants603 976 patients who underwent isolated CABG or PCI in the Spanish National Health System. The study period was divided in four 5-year intervals. Patients with acute myocardial infarction on admission were excluded.Primary and secondary outcomesWe investigated the volume of procedures nationwide, the changes of the risk profile of patients and in-hospital mortality of both techniques.ResultsWe observed a 2.2-fold increase in the rate of any type of myocardial revascularisation per million inhabitants-year: 357 (1998) to 776 (2017). 93 682 (15.5%) had a coronary surgery. PCI to CABG ratio rose from 2.2 (1998–2002) to 8.1 (2013–2017). Charlson’s index increased by 0.8 for CABG and 1 for PCI. The median annual volume of PCI/hospital augmented from 136 to 232, while the volume of CABG was reduced from 137 to 74. In the two decades, we detected a significant reduction of CABG in-hospital mortality (6.5% vs 2.6%, p<0.001) and a small increase in PCI (1.2% vs 1.5%, p<0.001). Risk adjusted mortality rate was reduced for both CABG (1.51 vs 0.48, p<0.001), and PCI (1.42 vs 1.05, p<0.001).ConclusionWe detected a significant increase in the volume of revascularisations (particularly PCI) in Spain. Risk-adjusted in-hospital mortality was significantly reduced.

Variability of Activated Clotting Time by Site of Sample Draw During Percutaneous Coronary Intervention: A Prospective Single-Center Study

Angiology ◽  
2021 ◽  
pp. 000331972199223
Author(s):  
Jacqueline H. Morris ◽  
Junsoo Alex Lee ◽  
Scott McNitt ◽  
Ilan Goldenberg ◽  
Craig R. Narins
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Unfractionated Heparin ◽  
Anticoagulation Therapy ◽  
Coronary Intervention ◽  
Clotting Time ◽  
Access Sheath ◽  
Arterial Blood ◽  
Activated Clotting Time ◽  
Guide Catheter ◽  
Percutaneous Coronary

The activated clotting time (ACT) assay is used to monitor and titrate anticoagulation therapy with unfractionated heparin during percutaneous coronary intervention (PCI). Observations at our institution suggested a considerable difference between ACT values drawn from varying arterial sites, prompting the current study. Patients undergoing PCI with unfractionated heparin therapy were prospectively enrolled. Simultaneous arterial blood samples were drawn from the access sheath and the coronary guide catheter. Differences between Hemochron ACT values were determined, and potential interactions with clinical variables were analyzed. Immediately postprocedure, the simultaneous mean guide and sheath ACTs were 327 ± 62 seconds and 257 ± 44 seconds, respectively, with a mean difference of 70 ± 60 seconds (P < .001). Nearly all (90%) ACT values obtained via the guide catheter were higher than the concurrent ACT drawn from the sheath. Logistic regression analysis demonstrated that lower weight-adjusted heparin doses and absence of diabetes were associated with a greater difference between the ACT values. We conclude that the ACT value is substantially greater when assessed via the guide catheter versus the access sheath. Although the biological mechanisms require further study, this difference should be considered when managing anticoagulation during PCI and when reporting ACT as part of research protocols.

Association between the rs342293 polymorphism and adverse cardiac events in patients undergoing percutaneous coronary intervention

2014 ◽  
Vol 111 (06) ◽  
pp. 1060-1066 ◽  
Author(s):  
Iciar Arbesu ◽  
Bernd Jilma ◽  
Gerald Maurer ◽  
Irene M. Lang ◽  
Christine Mannhalter ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Adverse Events ◽  
Coronary Intervention ◽  
Cardiovascular Outcome ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Cardiac Adverse Events

SummaryThe single nucleotide polymorphism (SNP) rs342293 has been shown to influence platelet number and mean platelet volume (MPV). We investigated the association between the rs342293 polymorphism and cardiovascular outcome in a prospective cohort study. The rs342293 polymorphism was analysed in 404 patients with coronary artery disease undergoing percutaneous coronary intervention. The rates of cardiac adverse events were recorded during two years of follow-up. The polymorphism was associated with MPV (median 10.1 fL, interquartile range [IQR]: 9.6 to 10.6 in patients with the CC-allele vs 10.4 fL, IQR: 9.9 to 11.1 in G>C SNP carriers; p<0.001), but not with platelet count. Survival analysis indicated that carriers of the rs342293 G variant had a substantially higher risk to develop cardiac adverse events compared with wild type carriers during two years of follow-up (33% vs 22%; adjusted hazard ratio = 1.63, 95% confidence interval = 1.06–2.52, p=0.027). The rs342293 SNP could explain 2.9% of the variability in MPV (p=0.01). In conclusion, patients undergoing coronary stenting who carry the G-variant of the rs342293 SNP which is associated with larger MPV are at higher risk for adverse cardiovascular outcome.

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