Abstract
Objectives: In this study, we intend to analyze the feasibility and efficacy of very low frame rate fluoroscopy (VLFF) protocol using a combination of 3.8 and 7.5 fps while performing Percutaneous Coronary Intervention (PCI).Methods: A retrospective cohort including 193 patients undergoing PCI under the VLFF protocol (Post-VLFF group) was compared with a retrospective cohort of 133 patients, who underwent PCI prior to implementation of VLFF protocol (Pre-VLFF group). In the Pre-VLFF group, all PCIs were performed using fluoroscopy frame rate of 15 fps. In the Post-VLFF group, 3.8 fps was used to guide catheter engagement, coronary lesion wiring, pre-and post-dilation, and 7.5 fps was used for lesion assessment and stent placement. Increasing use of fluoroscopic storage in place of cineangiography was also encouraged. Cine acquisition in both groups was performed at 15 fps. Primary endpoint was radiation exposure measured by Air Kerma. Secondary endpoints were procedure related outcomes and patient related outcomes (Major Adverse Cardiac Events including all-cause mortality, Target Lesion Failure, Myocardial Infarction, and Stroke).RESULTS: Post-VLFF group showed 74.7% reduction in Air Kerma as compared to Pre-VLFF group (433 ± 27 mGy vs. 1,714 ± 140 mGy; p < 0.0001), with no increase in the fluoroscopy time (15.38 ± 0.98 min Post-VLFF vs. 17.06 ± 1.29 min Pre-VLFF; p = 0.529) and contrast volume (116.5 ± 4.9 ml Post-VLFF vs. 116.7 ± 6 ml Pre-VLFF; p = 0.700). Both groups had comparable procedural success and complications rates as well as incidence of MACE.Conclusions: The very low frame rate fluoroscopy protocol is a feasible, effective, and safe method to significantly reduce the radiation exposure during PCI without any compromise on procedural and patient outcomes.
Highlights
Percutaneous coronary intervention (PCI) has an indispensable role in the management of obstructive coronary artery disease
We propose to examine the feasibility and efficacy of a novel very Low Frame rate Fluoroscopy (VLFF) protocol during PCI and its effect on radiation exposure, procedural outcome and patient related outcomes assessed at 1 year
We have demonstrated that adoption of a simple protocol of reducing fluoroscopy frame rate can decrease the radiation exposure to patient by 74.7%
Summary
Percutaneous coronary intervention (PCI) has an indispensable role in the management of obstructive coronary artery disease. What started with the advent of balloon angioplasty in 1977 by Andreas Gruntzig has progressed to complex interventional procedures and implantation of drug eluting stents (1). The constant advancement of interventional cardiology has enabled us to attempt increasingly complex procedures which inadvertently has led to increase in fluoroscopy time and radiation exposure. It is imperative to monitor and minimize the hazardous effects of ionizing radiation to both the patient and health care providers (2). The side effects of radiation exposure include cancer, cataracts, non-malignant skin damage, and impaired fertility (3). Several studies have confirmed the increased incidence of cancer as well as posterior subcapsular lens opacities in interventional cardiologists (4). There are concerns over the possibility of a causal relationship between left sided brain tumors and occupational radiation exposure in interventional cardiologists (5)
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