login
Password reminder
Cardiovascular News
Contact the editor Visit Cardiovascular News Twitter feed Visit Cardiovascular News Facebook page
 

Radiation exposure during coronary angiography via transradial or transfemoral approaches: Does operator experience matter?


Wednesday, 25 Jul 2012 16:53
Binita Shah
Binita Shah

By Binita Shah

 

Cumulative radiation exposure to both patients and operators has become a topic of great interest given the overall increased use of both cardiovascular and non-cardiovascular imaging modalities. This is all the more important with the increasing usage of multimodality imaging, including non-invasive (single-photon emission computed tomography, computed tomography angiography) and invasive procedures in patients with known or suspected coronary artery disease.

 

The risks of increased radiation exposure, in the short run, include dermatologic burns for patients and, in the long run, increased risk of malignancy for both patients and operators.

 

At the same time, there is a growing trend to perform invasive coronary procedures utilising the transradial approach due to decreased major bleeding complications and increased patient satisfaction compared with the transfemoral approach. However, there is a learning curve for transradial approach for coronary angiography and intervention, and it is associated with longer procedural and fluoroscopy times. Whether the increased risk of radiation exposure is seen in transradial compared with transfemoral cases when procedures are performed by experienced operators is less clearly defined.

 

A retrospective analysis of radiation exposure during coronary angiography via transradial versus transfemoral approach performed by experienced operators at the New York University Langone Medical Center was presented on 15 May during an oral abstract session of the 2012 EuroPCR meeting. In a contemporary cohort of 1,696 patients undergoing coronary angiography with or without percutaneous coronary intervention (PCI) by experienced operators, transradial approach was associated with higher radiation exposure when compared with transfemoral approach. Experienced operators were defined as operators performing more than 75 PCIs per year for at least five years with more than 95% of cases using one type of approach to access.

In the diagnostic coronary angiogram only cohort, the main measure of radiation exposure, dose area product (DAP), was significantly 20.3% higher in the transradial compared with the transfemoral approach group. Junior cardiology fellows meaningfully participate during diagnostic procedures, and, therefore, a sensitivity analysis was performed excluding cases with a junior fellow present. Although median DAP decreased by 3.9% in the transradial and 0.6% in the transfemoral approach group, radiation exposure still remained significantly higher with transradial approach when the analysis was limited to procedures performed by very experienced operators without a junior cardiology fellow present.

 

In the PCI cohort, the majority were elective cases undergoing ad-hoc PCI with very low complication rates in both groups. Although lesion and procedural characteristics were well-balanced between the transradial and transfemoral approach groups, DAP was significantly 27.6% higher in the transradial compared with transfemoral approach groups.

 

Although this is a retrospective analysis of a single centre experience, we demonstrate that even in the hands of experienced operators, the radiation exposure still remains higher when using transradial approach compared with transfemoral approach. This study is also one of the few large cohorts to focus on a group of experienced operators and measure DAP, a better estimate of patient radiation dose than fluoroscopy time, as the primary outcome of interest. While transradial procedures may have other advantages (reduced access site complications/bleeding), the amount of radiation administered should also be considered with this approach.


Binita Shah is an interventional cardiologist, New York University School of Medicine, New York, USA




Add New Comment

Most popular


Abbott to acquire St Jude Medical
Tuesday, 03 May 2016
Abbott is set to acquire St Jude Medical, expanding its portfolio to cover cardiovascular markets such as atrial fibrillation, structural heart and heart failure as well as neuromodulation. The ... Abbott to acquire St Jude Medical

French hospital celebrates 30 years of implanting artificial hearts
Wednesday, 13 Apr 2016
La Pitié-Salpêtrière Hospital (Paris, France), the world’s leading artificial heart centre, is celebrating the 30th anniversary of the first Total Artificial Heart implantation. The centre has now ... French hospital celebrates 30 years of implanting artificial hearts

Tuesday, 05 Apr 2016
One-month, follow-up patient cohort data from the Revelution trial of Medtronic’s novel drug-filled stent indicate that device is associated with rapid vessel healing without inflammation, as ... Early data show good rapid healing for Medtronic’s investigational drug-filled stent

Features


Exploring the role of P2Y12 inhibitor monotherapy after dual antiplatelet therapy
Monday, 09 May 2016
According to Usman Baber, TWILIGHT is a unique and innovative study in that the experimental intervention is to withdraw rather than add to existing background pharmacotherapy. In this commentary, he ... Exploring the role of P2Y12 inhibitor monotherapy after dual antiplatelet therapy

The role of sutureless and rapid-deployment valves
Tuesday, 05 Apr 2016
Antonio Miceli explores the data for sutureless and rapid-deployment surgical valves for the management of patients with severe aortic stenosis. He also reviews the place of these new devices ... The role of sutureless and rapid-deployment valves

Profiles


Alexandra Lansky
Monday, 07 Mar 2016
Alexandra Lansky (Director, Heart and Vascular Clinical Research Program, Yale University School of ... Alexandra Lansky

Corrado Tamburino
Tuesday, 20 Oct 2015
Corrado Tamburino (full professor of Cardiology, Ferrarotto & Policlinico Hospitals, University of C... Corrado Tamburino

Cardiac Rhythm News Vascular News Cardiovascular News Interventional News Spinal News NeuroNews
BIBA Medical BIBA MedTech Insights CX Symposium ilegx
Password Reminder

BIBA Medical, 526 Fulham Road, Fulham, London, SW6 5NR.
TEL: +44 (0)20 7736 8788 FAX: +44 (0)20 7736 8283 EMAIL: 
info@bibamedical.com
© BIBA Medical Ltd is a company registered in England and Wales with company number 2944429.
VAT registration number 730 6811 50.
Site Map | Terms and Conditions