Patient dose in cardiac radiology.

INTRODUCTION: In diagnostic and interventional cardiology procedures performed with the use of X-ray diagnostic imaging systems, the long fluoroscopy time and the large number of cine projections, as well as the repetition of the procedure due to the recurrence of the lesion--a common event--result in a high locally delivered skin dose, which may even lead to patient skin necrosis. The purpose of this study was to collect information in order to estimate the patient dose during coronary angiography and coronary angioplasty procedures, using the dose-area product measuring system of the X-ray angiographic machine. METHODS: Dose-area product (DAP), fluoroscopy time, number of sequences and frames per sequence were collected for each of 108 coronary angiography and 101 coronary angioplasty procedures, using the dedicated X-ray machine of the hospital's haemodynamic department, where more than 3000 procedures are performed per year. RESULTS: The median values of DAP were 19.96 and 40.17 Gy.cm(2) for coronary angiography and angioplasty, respectively; fluoroscopy times were 7.7 and 23.4 minutes; and the numbers of frames were 457 and 641, respectively. There was a strong correlation between DAP and fluoroscopy time, the number of frames per sequence, and hence the cine recording time. CONCLUSIONS: The entrance skin dose delivered to the patient in the haemodynamic department was lower than that of other studies, although the mean fluoroscopy time per patient was longer. The practices in use satisfy the diagnostic reference levels as far as DAP values and number of frames per patient are concerned, but not with regard to fluoroscopy time. We did not find the correlation between doctors' experience and DAP values reported in other studies, as we did not take into account the complexity index of the lesion.

Success, safety, and efficacy of implantation of diamond-like carbon-coated stents.

The aim of this study was to evaluate safety and clinically defined efficacy of the implantation of a new stent coated with diamond-like carbon (DLC stent), in a group of patients who underwent percutaneous transluminal coronary revascularization procedures in two hemodynamic centers. This study was an observational prospective nonrandomized study that included 196 patients with a total of 236 significant de novo atheromatous coronary lesions, in which 245 DLC stents were implanted. The primary end point of this study was a composite of major cardiovascular events (death or acute myocardial infarction with or without Q) and need for target lesion revascularization (TLR) or target vessel revascularization (TVR) procedure during the first 48 hours and at 6 months after the DLC stent implantation. All patients had a myocardial perfusion imaging study with Tl(201) at 6 months after DLC stent implantation. Only patients with a myocardial perfusion imaging study indicative of myocardial ischemia were then submitted for a new coronary angiogram. No major cardiovascular event or emergency TVR occurred during hospitalization. At 6-month follow-up no major cardiovascular event occurred either, whereas the rate for TLR was 5.6% and that for TVR was 7.65%. This preliminary study provides enough clinical evidence that implantation of intracoronary bare metal stents coated with diamond-like carbon is associated with high success rates, safety, and efficacy, both in the hospital and at the 6-month follow-up after the interventional procedure.

Unexpected opening of a totally occluded septal branch originating from an atheromatous lesion successfully treated with angioplasty and stenting.

In about 50% of patients who undergo a percutaneous coronary intervention for an atheromatous lesion there is a side branch that is involved in or borders on the lesion. In such cases, the invasive cardiologist must make every attempt to rescue this branch. We present an unusual case of unexpected opening of a side branch of a coronary artery after balloon angioplasty and stenting of the main vessel. In a patient with subtotal occlusion of the anterior descending coronary artery, angioplasty and stenting caused the opening of a previously totally occluded septal branch that originated from within the treated atheromatous lesion. This case is an unusual example of atheromatous plaque shift that had an unexpectedly beneficial result.