Usefulness of rotational spin for coronary angiography in patients with advanced renal insufficiency

Abstract

Coronary angiography in patients with advanced renal insufficiency is typically restricted to cases of life-threatening circumstances such as acute myocardial infarction and unstable angina. To gather a large amount of visual information with a minimum number of cine runs, and consequently, with a minimum volume of contrast medium, we rotated the gantry at 40°/s throughout an angle of 120°, from the right toward the left anterior oblique positions. This technique of rotational spin during cinegraphic runs has not yet become established in invasive cardiology. Three experienced cardiologists independently evaluated all coronary segments in rotational versus standard coronary angiography modes for 15 patients, on the basis of an 11-point scale (0 = cardiac spin far better to 10 = standard mode far better). A score of 5 signified that there was no difference in quality between the 2 modes. The arithmetic mean of the assessment values was 4.9 ± 0.3 for coronary segments, 5.4 ± 1.3 for coronary lesions, 5.1 ± 1.4 for bifurcations, and 5.0 ± 0.1 for coronary flow. The arithmetic means for the volume of contrast medium (25 ± 4 ml), for the overall dose area product (8.6 ± 4.5 Gy × cm 2), and for the number of cine graphic frames (203 ± 65) for a diagnostic cardiac spin were significantly below published typical values in standard mode. Cardiac spin enables 3-dimensional coronary impression under conditions of adequate image quality and represents a new, useful, and beneficial method in invasive cardiology for applications involving the special indication of advanced renal insufficiency.