Assessment of Local Dose Reference Values for Recanalization of Chronic Total Occlusions and Other Occlusions in a High-Volume Catheterization Center

Abstract

The increasing number and complexity of these procedures have led to a higher number of patients at risk for tissue reactions like skin injuries. Monitoring of their dose indicators is essential in recognizing these patients. The aim of this work was to determine local diagnostic reference levels (DRLs) for recanalization of chronic total occlusion (CTO) and other occlusions procedures. All data from patients who underwent cardiac procedures were reviewed and classified according to their complexity. Dose indicators such as fluoroscopy time (FT), dose area product (DAP), and air kerma at patient entrance reference point (AKr) were recorded. Correlations with patient's body mass index, operators, procedure strategy, and complexity were studied. For CTO, the mean DAP, AKr, and FT were 252 ± 234 Gycm(2), 3,985 ± 3,579mGy, and 47 ± 36minutes, respectively. To better reflect the non-Gaussian distribution of data, the median and the 75th percentile values were also reported: median DAP, 172 Gycm(2); 75th percentile DAP, 350 Gycm(2); median AKr, 2,714mGy; and 75th percentile AKr, 5,921mGy. A tentative new set of values were suggested to take into account the complexity difference in recanalization of total occlusions according to their antegrade or retrograde approach. These approach-specific DRLs for total occlusions were mean DAP (120 ± 114 Gycm(2)), mean AKr (1,789 ± 1,933mGy), and mean FT (22 ± 18minutes) for antegrade approach and mean DAP (459 ± 304 Gycm(2)), mean AKr (6,881 ± 4,243mGy), and mean FT (82 ± 40minutes) for retrograde approach. The other significant values were median DAP (84 Gycm(2)), 75th percentile DAP (147 Gycm(2)), median AKr (1,160mGy), and 75th percentile AKr (2,176mGy) for antegrade approach and median DAP (422 Gycm(2)), 75th percentile DAP (552 Gycm(2)), median AKr (6,295mGy), and 75th percentile AKr (8,064mGy) for retrograde approach. In conclusion, a set of local DRL values from a large center were assessed. DRLs were provided for antegrade and retrograde approaches, reflecting the difference in difficulty from these 2 kinds of CTOs. The wide dose estimator values variations were explained through procedure complexity. The values obtained for the other more classic percutaneous coronary interventions were comparable with those found in the literature.