Impact of guidewire selection and operator expertise on radiation exposure in transradial angiography

Journal of Cardiothoracic Surgery

Shuzheng Lv¹  Yun Shen²  Guoxin Tong²  Liang Zhou²  Xianhua Ye²  Xiaoshan Tong²  Ningfu Wang²  Jianmin Yang² 

[1] Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No.2, Anzhen Road, Beijing 100029, China;Department of Cardiology, Hangzhou Hospital (Hangzhou No.1 Municipal Hospital), Nanjing Medical University, Hangzhou, China

关键词: Procedure time;    Fluoroscopy time;    Transradial approach;    Coronary angiography;   

Others  :  1136117
DOI  :  10.1186/s13019-014-0194-5

 received in 2014-08-30, accepted in 2014-11-27,  发布年份 2014

【 摘 要 】

Background

Several studies have implied that the time of radiation exposure for patients and operators during the transradial approach for coronary angiography (TRA) is associated with the use of different guidewire or catheter and operator’s finesse. This study aimed to assess the effects of non-hydrophilic or hydrophilic guidewire and operator expertise on fluoroscopy time and procedure time of TRA and further effects on the procedure safety.

Methods

A total of 1035 consecutive patients undergoing TRA were recruited prospectively and respectively divided into non-hydrophilic guidewire and hydrophilic guidewire group, or well-experienced group and less-experienced group. The primary endpoints were fluoroscopy time and procedure time. Secondary endpoints included contrast volume, cost, guidewire exchange, switchover and complications.

Results

TRA by non-hydrophilic guidewire group showed shorter fluoroscopy time and procedure time compared with hydrophilic guidewire group, similar results were found between well-experienced group and less-experienced group. Moreover, using of non-hydrophilic guidewire significantly reduced the incidence of hematoma and abnormal guidewie advancement, well-experienced group showed less dosage of contrast volume, lower incidence of radial artery spasm and frequency of guidewire exchange.

Conclusions

TRA by non-hydrophilic guidewire and well-experienced operator can decrease radiation exposure of patients and operators through reducing the fluoroscopy time and procedure time and further increase procedure safety. These will contribute to the optimization of TRA procedure and promote its widely application.

【 授权许可】

   
2014 Yang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Nathan SRS: Radial versus femoral access for percutaneous coronary intervention: implications for vascular complications and bleeding. Curr Cardiol Rep 2012, 14:502-509.
• [2]Frangos Noble CDBE, Noble S: Transradial approach for coronary angiography and angioplasty: the gold standard. Rev Med Suisse 2011, 7:528-532.
• [3]Schussler JM: Effectiveness and safety of transradial artery access for cardiac catheterization. Proc (Bayl Univ Med Cent) 2011, 24:205-209.
• [4]Rodriguez-Leor OF-NE, Carrillo X, Mauri J, Rodriguez-Leor O, Fernandez-Nofrerias E, Carrillo X, Mauri J, Oliete C, Rivas Mdel C, Bayes-Genis A: Transradial percutaneous coronary intervention in cardiogenic shock: a single-center experience. Am Heart J 2013, 165:280-285.
• [5]Jang JS, Jin HY, Seo JS, Yang TH, Kim DK, Kim DK, Kim DI, Cho KI, Kim BH, Park YH, Je HG, Kim DS: The transradial versus the transfemoral approach for primary percutaneous coronary intervention in patients with acute myocardial infarction: a systematic review and meta-analysis. Euro Interv 2012, 8:501-510.
• [6]Shah B, Bangalore S, Feit F, Fernandez G, Coppola J, Attubato MJ, Slater J: Radiation exposure during coronary angiography via transradial or transfemoral approaches when performed by experienced operators. Am Heart J 2013, 165:286-292.
• [7]Yuan MK, Tsai DC, Chang SC, Yuan MC, Chang SJ, Chen HW, Leu HB: The risk of cataract associated with repeated head and neck CT studies: a nationwide population-based study. Am J Roentgenol 2013, 201:626-630.
• [8]Godino C, Maccagni D, Pavon AG, Viani G, Cappelletti A, Margonato A, Colombo A: Estimating incidence of organ cancer related to PCI radiation exposure in patients treated for acute and chronic total occlusions. J Invasive Cardiol 2013, 25:441-445.
• [9]Borghini ALGE, Picano E, Andreassi MG: Ionizing radiation and atherosclerosis: Current knowledge and future challenges. Atherosclerosis 2013, 230:40-47.
• [10]Andreassi MG, Cioppa A, Manfredi S, Palmieri C, Botto N, Picano E: Acute chromosomal DNA damage in humanlymphocytes after radiation exposure in invasive cardiovascular procedures. Eur Heart J 2007, 28:2195-2199.
• [11]Brix G, Berton M, Nekolla E, Lechel U, Schegerer A, Süselbeck T, Fink C: Cumulative radiation exposure and cancer risk of patients with ischemic heart diseases from diagnostic and therapeutic imaging procedures. Eur J Radiol 2013, 82:1926-1932.
• [12]Farman MTKN, Sial JA, Saghir T, Rizvi SN, Zaman KS: Comparison of fluoroscopy time during coronary angiography and interventions by radial and femoral routes- can we decrease the fluoroscopy time with increased experience? An observational study. Anadolu Kardiyol Derg 2011, 11:607-612.
• [13]Brasselet C, Blanpain T, Tassan-Mangina S, Deschildre A, Duval S, Vitry F, Gaillot-Petit N, Clément JP, Metz D: Comparison of operator radiation exposure with optimized radiation protection devices during coronary angiograms and ad hoc percutaneous coronary interventions by radial and femoral routes. Eur Heart J 2008, 29:63-70.
• [14]Lo TSRK, Chong AY, Bhatia G, Gunning M, Nolan J: Impact of access site selection and operator expertise on radiation exposure; a controlled prospective study. Am Heart J 2012, 164:455-461.
• [15]Barbeau GR: Radial loop and extreme vessel tortuosity in the transradial approach: advantage of hydrophilic-coated guidewires and catheters. Cardiovasc Interv 2003, 59:442-450.
• [16]McConnell EA: Performing Allen’s test. Nursing 1997, 27:26.
• [17]Varenne O, Jégou A, Cohen R, Empana JP, Salengro E, Ohanessian A, Gaultier C, Allouch P, Walspurger S, Margot O, El Hallack A, Jouven X, Weber S, Spaulding C: Prevention of arterial spasm during percutaneous coronary interventions through radial artery: the SPASM study. Catheter Cardiovasc Interv 2006, 68:231-235.
• [18]Dominici M, Diletti R, Milici C, Bock C, Placanica A, D'Alessandro G, Arrivi A, Italiani M, Buono E, Boschetti E: Operator exposure to x-ray in left and right radial access during percutaneous coronary procedures: OPERA randomised study. Heart 2013, 99:480-484.
• [19]Zhao Y, Ru L, Li J: Application of PTCA guidewire in abnormal assess of Transradial Coronary Procedures. Hebei Med J 2011, 33:2934-2935.
• [20]Sciahbasi A, Romagnoli E, Trani C, Burzotta F, Pendenza G, Tommasino A, Leone AM, Niccoli G, Porto I, Penco M: Evaluation of the “learning curve” for left and right radial approach during percutaneous coronary procedures. Am J Cardiol 2011, 108:185-188.
• [21]Kristić ILJ: Radial artery spasm during transradial coronary procedures. J Invasive Cardiol 2011, 23:527-531.
• [22]Kiemeneij FFD, Slagboom T, Laarman G, van der Wieken R: Hydrophilic coating aids radial sheath withdrawal and reduces patient discomfort following transradial coronary intervention: a randomized double-blind comparison of coated and uncoated sheaths. Catheter Cardiovasc Interv 2003, 59:161-164.
• [23]Jia DA, Zhou YJ, Shi DM, Liu YY, Wang JL, Liu XL, Wang ZJ, Yang SW, Ge HL, Hu B, Yan ZX, Chen Y, Gao F, Jia DA, Zhou YJ, Shi DM, Liu YY, Wang JL, Liu XL, Wang ZJ, Yang SW, Ge HL, Hu B, Yan ZX, Chen Y, Gao F: Incidence and predictors of radial artery spasm during transradial coronary angiography and intervention. Chin Med J 2010, 123:843-847.
• [24]Chen CWLC, Lin TK, Lin CD: A simple and effective regimen for prevention of radial artery spasm during coronary catheterization. Cardiology 2006, 105:43-47.
• [25]Coppola J, Patel T, Kwan T, Sanghvi K, Srivastava S, Shah S, Staniloae C: Nitroglycerin, nitroprusside, or both, in preventing radial artery spasm during transradial artery catheterization. J Invasive Cardiol 2006, 18:155-158.
• [26]Goldsmit A, Kiemeneij F, Gilchrist IC, Kantor P, Kedev S, Kwan T, Dharma S, Valdivieso L, Wenstemberg B, Patel T: Radial artery spasm associated with transradial cardiovascular procedures: Results from the RAS registry. Catheter Cardiovasc Interv 2014, 83:E32-E36.
• [27]Koga S, Ikeda S, Futagawa K, Sonoda K, Yoshitake T, Miyahara Y, Kohno S: The use of a hydrophilic-coated catheter during transradial cardiac catheterization is associated with a low incidence of radial artery spasm. Int J Cardiol 2004, 96:255-258.
• [28]Sciahbasi A, Romagnoli E, Burzotta F, Trani C, Sarandrea A, Summaria F: Transradial approach (left vs right) and procedural times during percutaneous coronary procedures: TALENT study. Am Heart J 2011, 161:172-179.
• [29]Kawashima O, Endoh N, Terashima M, Ito Y, Abe S, Ootomo T, Ogata K, Honda H, Takizawa K, Miyazaki Y, Sugawara D, Komatsu M, Sawazi Y, Ozaki T, Uchimuro T, Meguro T, Isoyama S: Effectiveness of right or left radial approach for coronary angiography. Catheter Cardiovasc Interv 2004, 61:333-337.
• [30]Hamon M, Gomes S, Clergeau MR, Fradin S, Morello R, Hamon M: Risk of acute brain injury related to cerebral microembolism during cardiac catheterization performed by right upper limb arterial access. Stroke 2007, 38:2176-2179.
• [31]Pelliccia F, Trani C, Biondi-Zoccai GG, Nazzaro M: Comparison of the feasibility and effectiveness of transradial coronary angiography Via right versus left radial artery approaches (from the PREVAIL study). Am J Cardiol 2012, 110:771-775.
• [32]Rao SV, Cohen MG, Kandzari DE, Bertrand OF, Gilchrist IC: The transradial approach to percutaneous coronary intervention: historical perspective, current concepts, and future directions. J Am Coll Cardiol 2010, 55:2187-2195.