Sakano Tomokazu, Iwamoto Tatsushi, Kuribara Takuya, Sakamoto Hajime, Tajima Osamu, Hamano Yasuatu, Maruyama Masayuki, Kikuchi Tatsuya, Tsukamoto Atsuko, Kato Kyouichi
Department of Radiology, Yokohama City University Medical Center.
Nihon Hoshasen Gijutsu Gakkai Zasshi. 2017;73(1):51-56. doi: 10.6009/jjrt.2017_JSRT_73.1.51.
During percutaneous coronary intervention (PCI) for chronic total occlusion (CTO), longer fluoroscopic time as compared with PCI for non-CTO lesions may cause skin injury by increased radiation. We have performed a multi-center observational study comparing the exposed dose during the PCI of CTO (CTO group) and during the PCI of non-CTO lesions (non-CTO group). Exposure doses were assessed in 313 patients with CTO and 3,310 patients with non-CTO lesions. Total fluoroscopy time (59.0 ±35.5 vs 26.8 ±18.8 min, p<0.0001) and the total air kerma (2.76±2.11 vs 1.27±0.94 Gy, p<0.0001) were significantly greater in the CTO group than in the non-CTO group. The maximum air kerma of the CTO group was 13.62 Gy. Informed consent about the risk of transient depilation and the transient erythema is required for the case with radiation dose over 3 Gy. The frequency of the patient who received radiation >3 Gy was significantly higher in the CTO group as compared with the non-CTO group (34.1% vs 4.9%). Therefore, informed consent before an operation and postoperative follow-up are indispensable for the performed PCI of CTO. Moreover, comprehensive understanding of the exposure dose during operation and to record the final exposure dose may be extremely important for the radiological technologists.
在对慢性完全闭塞病变（CTO）进行经皮冠状动脉介入治疗（PCI）时，与非CTO病变的PCI相比，更长的透视时间可能会因辐射增加而导致皮肤损伤。我们进行了一项多中心观察性研究，比较CTO的PCI过程中（CTO组）和非CTO病变的PCI过程中（非CTO组）的暴露剂量。对313例CTO患者和3310例非CTO病变患者的暴露剂量进行了评估。CTO组的总透视时间（59.0±35.5 vs 26.8±18.8分钟，p<0.0001）和总空气比释动能（2.76±2.11 vs 1.27±0.94 Gy，p<0.0001）显著高于非CTO组。CTO组的最大空气比释动能为13.62 Gy。对于辐射剂量超过3 Gy的病例，需要获得关于短暂脱毛和短暂红斑风险的知情同意。与非CTO组相比，CTO组接受辐射>3 Gy的患者频率显著更高（34.1% vs 4.9%）。因此，对于所进行的CTO的PCI，术前知情同意和术后随访是必不可少的。此外，对手术期间的暴露剂量有全面的了解并记录最终暴露剂量，对放射技师可能极其重要。
