Bacci Elodi, Chiarito Mauro, Sanz-Sanchez Jorge, Leone Pier Pasquale, Gohar Aisha, Novelli Laura, Kovacic Mihajlo, Regazzoli Damiano, Reimers Bernhard, Contorni Francesco, Ghionzoli Nicolò, Cameli Matteo, Gasparini Gabriele L
Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Toscana, Italy.
Humanitas Research Hospital IRCCS, Milan, Rozzano, Italy.
Catheter Cardiovasc Interv. 2023 Apr;101(5):911-917. doi: 10.1002/ccd.30605. Epub 2023 Mar 1.
Chronic total occlusion (CTO) revascularization is a major source of radiation for both patients and physicians. Therefore, efforts to minimize radiation during CTO percutaneous coronary intervention (PCI) are highly encouraged.
To evaluate the impact of an Ultra Low fluoroscopic Dose Protocol (ULDP), based on 3.75 frames per second for the fluoroscopy and 7.5 frames per second for the cine acquisition, during CTO PCI.
One hundred fifty consecutive patients who underwent CTO PCI were retrospectively enrolled. Eighty-five underwent standard dose protocol (SDP) and 65 ULDP. Radiation exposure and acute clinical outcomes were compared between groups. Results were stratified according to lesion complexity.
Patients undergoing ULDP, as compared to those undergoing SDP, showed a significant reduction of kerma area product, both for simple lesions (6861.0 vs. 13236.0 mGy × cm ; p = 0.014) and complex lesions (CL) (8865.0 vs. 16618.0 mGy × cm ; p < 0.001). Similarly, Air Kerma (AK) was lower when ULDP was used (1222.5 vs. 2015.0 cGy in SL, p = 0.134; 1499.0 vs. 2794.0 cGy in CL, p < 0.001). No significant differences were reported regarding procedural success and in-hospital major adverse cardiovascular events between groups. Notably, there was not any crossover from ULDO to SDP due to poor quality images. Interestingly, fluoroscopy time, procedural time and contrast volume was significantly lower in patients undergoing ULDP only for CLs.
ULDP significantly reduces radiation exposure in the setting of high complexity procedures such as CTO PCI. This reduction seemed to be greater with increased procedural complexity and did not impact acute success or adverse clinical events.
慢性完全闭塞病变（CTO）血管重建术对患者和医生来说都是辐射的主要来源。因此，强烈鼓励在CTO经皮冠状动脉介入治疗（PCI）期间尽量减少辐射。
评估基于每秒3.75帧的透视和每秒7.5帧的电影采集的超低透视剂量方案（ULDP）在CTO PCI期间的影响。
回顾性纳入150例连续接受CTO PCI的患者。85例接受标准剂量方案（SDP），65例接受ULDP。比较两组之间的辐射暴露和急性临床结果。结果根据病变复杂性进行分层。
与接受SDP的患者相比，接受ULDP的患者，无论是简单病变（6861.0对13236.0 mGy×cm；p = 0.014）还是复杂病变（CL）（8865.0对16618.0 mGy×cm；p < 0.001），比释动能面积乘积均显著降低。同样，使用ULDP时空气比释动能（AK）较低（简单病变中为1222.5对2015.0 cGy，p = 0.134；复杂病变中为1499.0对2794.0 cGy，p < 0.001）。两组之间在手术成功率和院内主要不良心血管事件方面未报告有显著差异。值得注意的是，由于图像质量差，没有从超低剂量方案（ULDO）转换到SDP的情况。有趣的是，仅对于复杂病变，接受ULDP的患者的透视时间、手术时间和造影剂用量显著更低。
在CTO PCI等高复杂性手术中，ULDP显著降低辐射暴露。随着手术复杂性增加，这种降低似乎更大，并且不影响急性手术成功率或不良临床事件。
