Herbert and Sandi Feinberg Interventional Cardiology and Heart Valve Center at Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY, USA.
EuroIntervention. 2017 Dec 8;13(12):e1468-e1474. doi: 10.4244/EIJ-D-16-00216.
Radiation exposure and prolonged procedure time continue to limit the complexity of CTO-PCI procedures attempted. This study aimed to assess the impact of radiation dose-limiting equipment on radiation dosage and fluoroscopic time in chronic total occlusion (CTO) percutaneous coronary interventions (PCI).
Retrospective clinical and dosimetric data from diagnostic catheterisations (DXC) and CTO-PCI procedures performed on one of three variants of interventional fluoroscopic equipment were collected. Fluoroscopic time, air kerma, kerma area product and contrast utilisation were stratified by procedure type and compared among equipment types. To standardise comparisons among equipment configurations, an efficiency index (EI) was calculated. In total, 2,947 DXC and 276 CTO-PCI procedures were studied. For DXC, radiation dose (AK) decreased by 45% (despite modest increases in fluoroscopic time [FT]) between the reference (REF) and moderately dose-optimised (ECO) machines. A further 20% decrease in AK was observed on the highly dose-optimised machine (CLA). For CTO-PCI, AK declined by almost half (48%), despite a 76% increase in FT and higher procedural success rates (69.8% versus 83.0%) between REF and CLA. • Conclusions: Novel dose-optimised fluoroscopic equipment allows longer FT with a decrease in radiation dose to both patient and operator. This should allow operators to undertake increasingly longer and more complex procedures and reduce operators' lifetime irradiation.
辐射暴露和较长的手术时间仍然限制了尝试进行 CTO-PCI 手术的复杂性。本研究旨在评估辐射剂量限制设备对慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）中辐射剂量和透视时间的影响。
收集了三种介入透视设备中一种的诊断性导管插入术（DXC）和 CTO-PCI 手术的回顾性临床和剂量学数据。按手术类型对透视时间、空气比释动能、比释动能面积乘积和对比剂使用情况进行分层，并比较设备类型之间的差异。为了标准化设备配置之间的比较，计算了效率指数（EI）。共研究了 2947 例 DXC 和 276 例 CTO-PCI 手术。对于 DXC，尽管透视时间（FT）略有增加，但辐射剂量（AK）在参考（REF）和中度剂量优化（ECO）机器之间降低了 45%。在高度剂量优化的机器（CLA）上，AK 进一步降低了 20%。对于 CTO-PCI，AK 下降了近一半（48%），尽管 FT 增加了 76%，并且手术成功率更高（REF 为 69.8%，CLA 为 83.0%）。
新型剂量优化透视设备允许更长的 FT，同时降低患者和操作人员的辐射剂量。这应该允许操作人员进行越来越长和更复杂的手术，并减少操作人员的终身照射。
