Medizinische Klinik I, Klinikum Darmstadt GmbH, Darmstadt, Germany.
Department of Cardiology, Juntendo University Urayasu Hospital, Tokyo, Japan.
Cardiovasc Revasc Med. 2022 Mar;36:58-64. doi: 10.1016/j.carrev.2021.04.020. Epub 2021 Apr 22.
The treatment of chronic total coronary occlusions (CTO) carries the highest radiation exposure among percutaneous coronary interventions (PCI). In order to minimize radiation damage, we need to understand and optimize the contribution of all components of radiation exposure.
A total of 1000 CTO procedures performed between 2011 and 2020 were compared according to implemented radiation modifications. Group 1 used the original set-up of the X-ray equipment (Artis Zee, Siemens). In group 2 a modified protocol aimed at reducing the fluoroscopy exposure, in group 3 further modifications aimed at reducing cineangiographic exposure.
Despite an increased lesion complexity, Air Kerma (AK) was reduced from 2619 mGy (1653-4574) in group 1 to 2178 mGy (1332-3500; p < 0.001) in group 2 by mainly reducing fluoroscopic contribution by 54.1%, the cineangiographic contribution was lowered by only 6.6%. In group 3 AK dropped drastically to 746 mGy (480-1225; p < 0.001) mainly by reducing the cineangiographic contribution by 53.4%, still there was a further reduction of fluoroscopy contribution of 8.2%. This also led to a reduction of the skin entry dose from 1038 mGy (690-1589) in group 2 to 359 mGy (204-591; p < 0.001) in group 3. This was achieved both in normal weight and obese patients, and both in antegrade and retrograde procedures.
The present study demonstrates that by modifying both the fluoroscopic and cineangiographic contribution to radiation exposure a drastic reduction of radiation risk can be achieved, even in obese patients. Currently accepted radiation thresholds may no longer be a limit for CTO PCI.
经皮冠状动脉介入治疗（PCI）中，慢性完全闭塞病变（CTO）的治疗带来的辐射暴露量最大。为了将辐射损伤降至最低，我们需要了解并优化辐射暴露的所有组成部分的贡献。
根据实施的辐射修正，比较了 2011 年至 2020 年间进行的 1000 例 CTO 手术。第 1 组使用 X 射线设备（西门子 Artis Zee）的原始设置。第 2 组采用旨在降低透视曝光的改良方案，第 3 组采用旨在降低电影血管造影曝光的进一步改良方案。
尽管病变复杂性增加，但空气比释动能（AK）从第 1 组的 2619 mGy（1653-4574）降至第 2 组的 2178 mGy（1332-3500；p < 0.001），主要是通过降低透视贡献降低 54.1%，仅降低了电影血管造影贡献 6.6%。第 3 组 AK 急剧下降至 746 mGy（480-1225；p < 0.001），主要是通过降低电影血管造影贡献 53.4%，透视贡献仍降低 8.2%。这也导致皮肤入射剂量从第 2 组的 1038 mGy（690-1589）降至第 3 组的 359 mGy（204-591；p < 0.001）。这在正常体重和肥胖患者以及顺行和逆行手术中均有实现。
本研究表明，通过修改透视和电影血管造影对辐射暴露的贡献，可以大大降低辐射风险，即使在肥胖患者中也是如此。目前接受的辐射阈值可能不再是 CTO PCI 的限制。
