Dual-axis Rotational Coronary Angiography Research Articles

Usefulness of dual-axis rotational coronary angiography in primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction

Several studies have shown that dual-axis rotational coronary angiography (DARCA) reduces contrast medium volume and radiation exposure compared to conventional coronary angiography (CCA). However, there are no studies comparing the safety and usefulness of DARCA in primary percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (STEMI). The aim of this study was to investigate the effects of DARCA on contrast medium volume, radiation exposure, time course of treatment, and adverse events in primary PCI for patients with STEMI. A total of 82 patients undergoing primary PCI were included in this study. Subjects were propensity matched to 41 patients in the CCA group and 41 in the DARCA group. Data were retrospectively collected from in-patient medical records and the contrast medium volume and radiation exposure (dose-area product, DAP) during the PCI procedure was compared between the two groups. Contrast medium volume [100.0 (82.5–115.0) vs 110 (102.5–127.5) ml, p = 0.018, r = 0.26] and DAP [113.4 (74.3–141.1) vs 138.1 (100.5–194.7) Gy cm2, p = 0.014, r = 0.27] were significantly lower in the DARCA group, compared with the CCA group. Door to device time (68.7 ± 26.1 vs 76.5 ± 44.2 min, p = 0.33) were comparable between the two groups. There were no adverse events requiring treatment reported in either groups. DARCA may reduce contrast medium volume and radiation exposure in primary PCI for patients with STEMI, and can be used safely, without delaying reperfusion of the infarct-related coronary artery.

Dual-axis rotational coronary angiography versus conventional coronary angiography: a randomized comparison.

Dual-axis of rotational coronary angiography (RA), with one single cine acquisition during continuous C-arm motion along a pre-described path, is an alternative to conventional coronary angiography (CA). We assessed the performance of RA versus CA in a modern, experienced cath lab setting. Sixty-seven patients with suspected coronary artery disease undergoing invasive coronary angiography were randomized to CA (n = 35) or dual-axis RA (n = 32). CA was performed with four left and two right coronary artery acquisitions with manual contrast medium injection. In RA, one cine acquisition each was performed for the left (5 projections) and right coronary artery (3 projections) with a fixed amount of contrast medium applied by a power injector. In both groups, single cine acquisitions in additional angulations were performed to fully interpret the coronary system, if necessary. Procedural parameters and outcome were compared. Mean age was 63 ± 12years (64% males). Six additional projections were required in the RA group compared to 13 in the CA group (p = 0.173). Fluoroscopy duration (CA: 3 ± 3min, RA: 3 ± 2min, p = 0.748) and dose area product (CA: 1291 ± 761µGym2, RA: 1476 ± 679µGym2, p = 0.235) did not differ significantly between both groups. For CA, the amount of contrast medium (42 ± 13 vs. 46 ± 8ml, p = 0.022) and procedure time (8 ± 5 vs. 11 ± 3min, p < 0.001) were significantly lower. No major adverse event occurred during hospital stay. Dual-axis RA represents a feasible and safe alternative method to CA for obtaining coronary angiograms. However, no superiority was observed when performed by an experienced interventionalist with a modern system.

Is Dual-Axis Rotational Coronary Angiography Radiation Dose Reduction Achievable in a Population with 100% Suspected Coronary Artery Disease? A Randomized Trial

BackgroundPrevious studies have shown a reduction in radiation dose and contrast volume using dual-axis rotational coronary angiography (DARCA), but this has not been replicated in a population with 100% coronary artery disease (CAD). ObjectiveTo find if DARCA dose reduction is achievable in this population, we sought to compare the radiation dose, contrast volume, and procedure time between DARCA and conventional coronary angiography (CCA) techniques in a setting characterized by a prevalence of 100% suspected coronary artery disease. MethodsAn all-comer, prospective, randomized, open-label trial was conducted. Cine acquisition dose–area product (DAP), cumulative air kerma (AK), effective dose (E), fluoroscopic time, contrast volume, AK, cine acquisition DAP (CADAP), fluoroscopic DAP (F-DAP), and total DAP were compared between DARCA and CCA groups. ResultsWe included 503 consecutive patients with suspected CAD. 252 were assigned to DARCA and 251 to CCA. Stable coronary artery disease was reported in 465 cases and non-ST elevation acute coronary syndrome in 38. Mean age: 61.88 ± 11.2 years, male gender 70.2%. DARCA arm patients showed lower total E dose (6.85 [4.55–10.83] vs. 7.91 [5.58–11.94] Sv; P = .0023), and cine E (3.00 [2.00–4.00] vs. 4.00 [3.00–5.00] Sv; P < .0001). Total DAP was also lower (40.3 [26.8–63.7] vs. 46.5 [32.8–70.2] Gycm2; P = .0023), as a consequence of a lower CADAP (16.3 [10.5–22.9] vs. 23.4 [17.4–32.0] Gycm2; P < .0001), with lower AK (367 [248–1497] vs. 497 [381–1827] mGy; P < .0001), with less contrast medium used (90 [60.0–106.0] vs. 100 [75.0–120.0] mL; P = .014). ConclusionIn a population with 100% suspected coronary artery disease, DARCA provides accurate information required in CAD, is safe, and results in a significant decrease in contrast material volume and radiation dose compared with CCA. The required extra projections did not neutralize the DARCA radiation dose and contrast volume reduction achievements.

Comparison of diagnostic accuracy of dual-axis rotational versus standard coronary angiography

The data about the accuracy of dual-axis rotational coronary angiography (DARCA) in detecting coronary artery disease (CAD) is scare. This study aimed to compare the diagnostic accuracy of DARCA versus standard coronary angiography (SA). 70 patients with possible CAD underwent SA following by DARCA were prospectively enrolled. The primary endpoint was the non-inferiority comparison of the two modalities regarding diagnosis of CAD. Coronary lesion assessment, quantitative coronary angiography (QCA) analysis, and screening adequacy comparisons were performed. All images were analyzed by two independent reviewers except QCA analysis that was analyzed by the third independent reviewer. Radiation dose, contrast usage and procedural time were recorded. This trial is registered with ClinicalTrials.gov, Number NCT01776866. 63 of 70 patients were analyzed. DARCA was non-inferior to SA regarding the diagnosis of CAD (reviewer one-positive agreement: 100%, negative agreement: 100%, p = 1; p = 0.003 for non-inferiority; reviewer two-positive agreement: 96%, negative agreement: 95%, p = 1; p = 0.016 for non-inferiority). All reviewers showed good agreement between the two modalities for the diagnosis of CAD, coronary lesion assessment, QCA analysis, and screening adequacy, as reflected by kappa coefficients between 0.61 and 1.00. DARCA was associated with 41% reduction in radiation dose, 30% in contrast usage and 29% in procedure time (all p < 0.001). DARCA is clinically comparable to SA concerning the diagnostic accuracy for CAD, while markedly reduces radiation dose, contrast usage and procedure time.

Radiation Dose Reduction Comparing Dual Axis Rotational Coronary Angiography against Conventional Coronary Angiography in a Population with 100% Suspected Coronary Artery Disease: A Randomized Trial

We sought to compare the radiation dose, contrast volume, and procedure time between dual-axis rotational coronary angiography (DARCA) and conventional coronary angiography (CCA) techniques in a setting characterized by a prevalence of 100% suspected coronary artery disease.

Comparison of the Effect of Dual-Axis Rotational Coronary Angiography Versus Conventional Coronary Angiography on Frequency of Acute Kidney Injury, X-Ray Exposure Time, and Quantity of Contrast Medium Injected

Dual-axis rotational coronary angiography (DARCA) has already been shown to reduce both the amount of contrast medium and radiation exposure compared with conventional coronary angiography (CCA). However, a clinical benefit of such imaging modality has never been demonstrated. The aim of this study was to evaluate the efficacy of DARCA to prevent acute kidney injury (AKI) compared with CCA. Consecutive patients who underwent coronary angiography were enrolled to DARCA (n = 80) or CCA (n = 80). Patients presenting with ST-segment elevation myocardial infarction or previously underwent coronary artery bypass graft were excluded. The 2 groups were homogeneous in terms of both clinical and procedural characteristics. Total x-ray time and total amount of contrast medium were significantly lower in the DARCA group compared with the CCA group (x-ray time 3.2 minutes [1.8 to 7.0] vs 5.1 minutes [2.6 to 9.9], p = 0.002; contrast medium amount 40 ml [31 to 116] vs 80 ml [50 to 150], p <0.001). AKI more often occurred in the CCA group compared with the DARCA group (16 [20%] vs 4 [5%], p = 0.007). Moreover, in patients presenting with acute coronary syndrome (ACS) or who underwent percutaneous coronary intervention (PCI), AKI more often occurred in the CCA group compared with the DARCA group (ACS patients, 6 [29%] vs 2 [6%], p = 0.04, and PCI patients, 11 [33%] vs 0 [0%], p <0.001). In addition, in patients with high pretest probability of coronary artery disease, AKI more often occurred in the CCA group compared with the DARCA group (11 [55%] vs 2 [6%], p <0.001). In conclusion, DARCA significantly reduces both x-ray exposure and amount of contrast medium usage, thereby reducing the occurrence of AKI compared with CCA.

Dual-Axis Rotational Angiography is Safe and Feasible to Detect Coronary Allograft Vasculopathy in Pediatric Heart Transplant Patients: A Single-Center Experience.

Coronary allograft vasculopathy (CAV) is the leading cause of graft failure in pediatric heart transplant recipients, also adding to mortality in this patient population. Coronary angiography is routinely performed to screen for CAV, with conventional single-plane or bi-plane angiography being utilized. Dual-axis rotational coronary angiography (RA) has been described, mostly in the adult population, and may offer reduction in radiation dose and contrast volume. Experience with this in the pediatric population is limited. This study describes a single-institution experience with RA for screening for CAV in pediatric patients. The catheterization database at our institution was used to identify pediatric heart transplant recipients having undergone RA to screen for CAV. Procedural data including radiation dose, fluoroscopy time, contrast volume, and procedure time were collected for each catheterization. The number of instances in which RA was not successful, ECG changes were present, and CAV was detected were also collected for each catheterization. A total of 97 patients underwent 345 catheterizations utilizing RA. Median radiation dose-area product per kilogram was found to be 341.7 (mGy cm(2)/kg), total air kerma was 126.8 (mGy), procedure time was 69 min, fluoroscopy time was 9.9 min, and contrast volume was 13 ml. A total of 17 (2 %) coronary artery injections out of 690 could not be successfully imaged using RA. A total of 14 patients had CAV noted at any point, 10 of whom had progressive CAV. Electrocardiographic changes were documented in a total of 10 (3 %) RA catheterizations. Procedural characteristics did not differ between serial catheterizations. RA is safe and feasible for CAV screening in pediatric heart transplant recipients while offering coronary imaging in multiple planes compared to conventional angiography.

GW26-e4712 Randomized Comparison of Dual-Axis Rotational Versus Standard Coronary Angiography: A Non-inferiority Trial

GW26-e4712 Randomized Comparison of Dual-Axis Rotational Versus Standard Coronary Angiography: A Non-inferiority Trial

GW25-e4584 The safety and efficacy of dual-axis rotational coronary angiography in the diagnosis of coronary artery disease

GW25-e4584 The safety and efficacy of dual-axis rotational coronary angiography in the diagnosis of coronary artery disease

A randomized trial comparing dual axis rotational versus conventional coronary angiography in a population with a high prevalence of coronary artery disease.

To compare the safety, radiation dose, and contrast volume between dual axis rotational coronary angiography (DARCA) and conventional coronary angiography (CCA). CCA is performed in multiple, predefined stationary views, at different angulations around the patient, for both the left and right coronary arteries. DARCA (AlluraXperSwing™, Philips, the Netherlands) involves a pre-set rotation of the C-arm around the patient and allows for the visualization of each coronary artery in different views, using a single automatic pump contrast injection. From November 2012 to February 2013, 201 patients were randomly assigned to either CCA (n = 100) or DARCA (n = 101). Exclusion criteria included acute coronary syndrome (ACS), prior PCI or CABG. CCAs were performed in 4 acquisition runs for the left coronary artery and 2 to 3 acquisition runs for the right coronary artery, whereas DARCAs were performed in a single run for each coronary artery. Baseline demographics and clinical characteristics were similar for both groups. The overall prevalence of CAD was 77.6%. The DARCA group had a significant reduction in the amount of contrast, 60 ml (IQR: 52.5-71.5 ml) versus 76 ml (IQR: 68-87 ml), P < 0.0001; and radiation dose by Air Kerma, 269.5 mGy (IQR: 176-450.5) versus 542.1 mGy (IQR: 370.7-720.8), P < 0.0001. There were fewer patients requiring additional projections in the DARCA group: 54.0% versus 75.0%; P = 0.002. In a population with a high prevalence of CAD, DARCA was safe and resulted in a significant decrease in contrast volume and radiation dose.

Dual‐axis rotational coronary angiography can reduce peak skin dose and scattered dose: a phantom study

The purpose of this study was to evaluate peak skin dose received by the patient and scattered dose to the operator during dual‐axis rotational coronary angiography (DARCA), and to compare with those of standard coronary angiography (SA). An anthropomorphic phantom was used to simulate a patient undergoing diagnostic coronary angiography. Cine imaging was applied on the phantom for 2 s, 3 s, and 5 s in SA projections to mimic clinical situations with normal vessels, and uncomplicated and complicated coronary lesions. DARCA was performed in two curved trajectories around the phantom. During both SA and DARCA, peak skin dose was measured with thermoluminescent dosimeter arrays and scattered dose with a dosimeter at predefined height (approximately at the level of left eye) at the operator's location. Compared to SA, DARCA was found lower in both peak skin dose (range: 44%–82%, p < 0.001) and scattered dose (range: 40%–70%, p < 0.001). The maximal reductions were observed in the set mimicking complicated lesion examinations (82% reduction for peak skin dose, p < 0.001; 70% reduction for scattered dose, p < 0.001). DARCA reduces both peak skin dose and scattered dose in comparison to SA. The benefit of radiation dose reduction could be especially significant in complicated lesion examinations due to large reduction in X‐ray exposure time. The use of DARCA could, therefore, be recommended in clinical practice to minimize radiation dose.PACS numbers: 87.53.‐j, 87.53.Bn, 87.59.‐e, 87.59.C‐, 87.59.cf, 87.59.Dj

Comparison of a Safety Strategy Using Transradial Access and Dual‐Axis Rotational Coronary Angiography with Transfemoral Access and Standard Coronary Angiography

We sought to investigate the radiation exposure and contrast utilization associated with using a strategy of transradial access and rotational angiography (radial-DARCA) compared to the traditional approach of transfemoral access and standard angiography (femoral-SA). There is an increased focus on optimizing patient safety during cardiac catheterization procedures. Professional guidelines have highlighted physician responsibility to minimize radiation doses and contrast volume. Dual axis rotational coronary angiography (DARCA) is the most recently investigated type of rotational angiography. This new technique permits complete visualization of the left or right coronary tree with a single injection, and is felt to reduce contrast and radiation exposure. A total of 56 consecutive patients who underwent radial-DARCA were identified. From the same time period, an age- and gender-matched group of 61 patients who had femoral-SA were selected for comparison. Total volume of contrast agent used, fluoroscopy time, and 2 measures of radiation dose (dose area product and air kerma) were recorded for each group. Mean contrast agent use and patient radiation exposure of the radial-DARCA group were significantly less than that of the femoral-SA group. There was no significant difference in fluoroscopy time between the 2 groups. Physicians can successfully employ an innovative safety strategy of transradial access combined with DARCA that is feasible and is associated with lower radiation doses and contrast volume than femoral artery access and traditional coronary angiography approach.

Benefits of dual-axis rotational coronary angiography in routine clinical practice

Dual-axis rotational coronary angiography (DARCA) is a new imaging technique involving three-dimensional rotation of the gantry around the patient with simultaneous left to right and craniocaudal movements. This allows complete imaging of the left or right coronary tree with a single acquisition run. Previous small studies have indicated that DARCA is associated with reduced radiation dose and contrast use in comparison with standard coronary angiography (SCA). We conducted a registry of unselected patients undergoing DARCA or SCA. DARCA was used in 107 patients and SCA in 105 patients. Mean number of acquisition runs was 2.6 for DARCA and 6.9 for SCA (P < 0.0001). Mean radiation dose (dose-area product, DAP) was 30.4 Gy cm(2) for SCA and 15.9 Gy cm(2) for DARCA (P < 0.0001). Mean contrast volume was 41.7 ml for SCA and 25.7 ml for DARCA (P < 0.0001). Case time for DARCA in the first half of the study was 20.8 ± 1.4 min compared with 15.2 ± 2.0 min in the second half of the study (P = 0.0015), suggesting a learning curve. In the DARCA group, 64 % of patients required only two acquisition runs for complete and satisfactory imaging. There were no adverse effects resulting from DARCA. Two cases are presented to illustrate the diagnostic ability of DARCA. DARCA was associated with a 48 % reduction in radiation dose and 36 % reduction in contrast volume in comparison with SCA, with comparable diagnostic ability.

Greater radiation savings at higher body mass indexes with dual axis rotational coronary angiography

Greater radiation savings at higher body mass indexes with dual axis rotational coronary angiography

Coronary lesions quantification with dual-axis rotational coronary angiography

Coronary angiography (CA) has been the gold standard technique for studying coronary artery disease. It is based on the analysis of bidimensional orthogonal projections that may not be optimal to estimate determinate coronary segments. Rotational angiography "Xperswing" (DARCA) is a new technique that allows the visualization of the coronary arteries from multiple views, with a single contrast injection. The aim of this study is to evaluate the coronary lesions quantification with DARCA. Quantitative coronary analysis of significant coronary stenosis (>50%) was performed. Every lesion was measured in two different projections: the "optimal projection", obtained by DARCA and defined by the operator as the one with a better lesion qualification, and the "standard projection", corresponding to the usual projection closer to the optimal one in obliquity and angulation. Measures were performed twice and by two independent operators. Intra- and inter-observer correlation was estimated by Kappa index and variables were compared with t Student test (SPSS 14.0). 205 lesions in 147 patients were analyzed. Kappa coefficient intra-observer was 0.80 and 0.86 respectively with an inter-observer correlation index of 0.72. Lesion length and maximal diameter of the vessel were significantly greater in the group of RA. In the segments analysis, calculated length was longer for the first diagonal branch, first marginal obtuse artery, middle circumflex, middle and distal RCA and posterior descending artery, with greater reference diameters for proximal LAD and distal RCA. There were no significant differences for coronary stenosis grade. RA XperSwing provides a better visualization of coronary arteries improving lesions characterization, with longer measured lesions length and greater vessel diameters, especially in coronary segments with more angulation.

DUAL-AXIS ROTATIONAL CORONARY ANGIOGRAPHY CAN REDUCE PEAK SKIN DOSE AND SCATTERED DOSE: A PHANTOM STUDY

Objectivesto evaluate the peak skin dose received by the patient and scattered dose to the operator during the dual-axis rotational coronary angiography and compared to standard coronary angiography.MethodsAn anthropomorphic phantom...

THE SAFETY AND EFFICACY OF DUAL-AXIS ROTATIONAL CORONARY ANGIOGRAPHY IN THE DIAGNOSIS OF CORONARY ARTERY DISEASE

ObjectivesStandard coronary angiography (SA) is performed in multiple stationary views at different angles around the patient to evaluate the severity and location of the lesions. The procedure exposes patients to...

Dual-Axis Rotational Coronary Angiography: A New Technique for Detecting Graft Coronary Vasculopathy in Pediatric Heart Transplant Recipients

Annual surveillance coronary angiograpyhy to screen for graft coronary vasculopathy is routine practice after orthotopic heart transplantation. Traditionally, this is performed with direct coronary angiography using static single-plane or biplane angiography. Recently, technological advances have made it possible to perform dual-axis rotational coronary angiography (RA). This technique differs from standard static single-plane or biplane angiography in that a single detector is preprogrammed to swing through a complex 80° arc during a single injection. It has the advantage of providing a perspective of the vessels from a full arc of images rather than from one or two static images per contrast injection. The current study evaluated two coronary angiography techniques used consecutively at a single center to evaluate pediatric heart transplant recipients for graft coronary vasculopathy. A total of 23 patients underwent routine coronary angiography using both biplane static coronary angiography (BiP) and RA techniques at the Children's Hospital of Wisconsin from February 2009 to September 2010. Demographic and procedure data were collected from each procedure and analyzed for significance utilizing a Wilcoxon rank sum test. No significant demographic or procedural differences between the BiP and the RA procedures were noted. Specific measures of radiation dose including fluoroscopy time and dose area product were similar among the imaging techniques. The findings show that RA can be performed safely and reproducibly in pediatric heart transplant recipients. Compared with standard BiP, RA does not increase radiation exposure or contrast use and in our experience has provided superior angiographic imaging for the evaluation of graft coronary vasculopathy.

Angiografía coronaria con técnica rotacional doble: eficacia y seguridad frente a la coronariografía convencional

Background Conventional coronary angiography (CA) is the gold standard for the diagnosis of coronary artery disease. However, this technique requires several orthogonal projections to determine the severity of the disease. Dual-axis rotational coronary angiography (DARCA) is a new technique which acquires the image of each coronary artery using a single contrast injection, potentially reducing both radiation and contrast exposure. Objective The aim of this study was to determine the amount of contrast used, radiation exposure and diagnostic accuracy of DARCA compared to conventional CA. Methods We conducted a prospective, self-controlled study of consecutive patients undergoing elective coronary angiography to compare DARCA versus the conventional technique. All the angiographies were reviewed by two independent interventional cardiologists (observer 1 and observer 2) who evaluated agreement between both types of images. The observers evaluated firstly DARCA and three weeks later conventional CA images to prevent bias in their interpretation. Results The contrast volume used in the diagnostic procedure was significantly lower with DARCA (33.29 ± 11.2 ml vs. 17±5.4 ml; p < 0.01). Radiation exposure in the patient (235.6 ± 76.8 mGy vs. 82.7 ± 46.6 mGy; p <0.01) and operator was also significantly lower (5.7 ± 3.26 iSv vs. 2.48 ± 1.47 iSv; p <0.04). A slight difference and a strong correlation were seen in the number of lesions, vessel diameter and percentage of stenosis between both observers and both methods. Categorical assessment of percentage of stenosis also showed adequate agreement. Conclusion DARCA reduces the use of contrast agents and radiation exposure compared to the conventional technique without modifying the diagnostic accuracy of the method.

Efficacy and safety of dual-axis rotational coronary angiography versus conventional angiography

Efficacy and safety of dual-axis rotational coronary angiography versus conventional angiography