Author + information
- Ignacio Batista Rago,
- Pedro Trujillo,
- Gustavo Vignolo,
- Ariel Duran and
- Ricardo Lluberas
Radial approach is the most frequently used arterial access in our center for coronary interventions due to the lower rate of vascular complications, increased patient comfort, as well as decreased mortality in primary angioplasty. Previous studies showed controversial results regarding relative radiation dose received by the first operator (FO) when performing right radial (RRA) versus left radial approach (LRA).
The aim of the present study was to evaluate radiation dose received by the FO during coronary procedures through RRA and LRA.
This was a prospective randomized trial. From February 2014 to March 2014, patients older than 18, with an indication for coronary intervention were recruited. Exclusion criteria were: failure to achieve the randomized vascular approach, prior CABG with internal mammary artery graft, end stage renal failure and/or hemodialysis and patient preference. Radioprotection devices for the FO included: leaded equivalent skirt, vest and thyroid shield, leaded glasses, screen and curtain under table, as well as leaded equivalent skirt for the patient between waist and knees. All procedures were performed by three operators, who were equipped with 1 dosimeter (DMC3000 radiation detector), located on the outer left side of the thyroid shield. Clinical and procedural variables were recorded: duration of the study (minutes), fluoroscopy time (FT-minutes), number of scenes (NS), dose-area product (DAP-μGym2), total radiation (TR-μGym) and radiation dose to the FO (mSv). t test for comparison of means was used, with alpha value ≤ 0.05.
97 patients were randomly assigned to the RRA (45 patients) or the LRA (52 patients). 58 patients were men. The mean age was 63.3 ± 1.1 years (26-83 years). There were no significant differences related to cardiovascular risk factors, BMI and clinical presentation between groups. Study duration 34.8 ± 3.9 vs. 32.8 ± 3.7 (p = 0.998), number of scenes (NS) 16 ± 1 vs. 14 ± 1 (p = 0.277), fluoroscopy time 11.7 ± 1.4 vs. 10.2 ± 1.4 (p = 0.441) were similar between groups, but the LRA was associated with greater dose-area product (μGym2) 10322,0 ± 1046,4 vs. 7117,7 ± 807,4 (p = 0.016), total radiation dose 1932,9 ± 136,3 vs. 1260,6 ± 136,3 (p = 0.009) and radiation dose to the FO 53,2 ± 87,5 vs. 30,4 ± 5,3 (p = 0.013).
RRA was associated with a statistically significant lower dose of radiation received by the FO as compared to LRA. These results argue in favor of the RRA as the first choice when performing coronary interventions by radial approach.