Comparison of rotational with conventional coronary angiography

• Published in: The American heart journal Vol. 160; no. 3; pp. 552 - 563
• Main Authors: Empen, Klaus, MD, Kuon, Eberhard, MD, Hummel, Astrid, MD, Gebauer, Chris, MS, Dörr, Marcus, MD, Könemann, Raik, MSc, Hoffmann, Wolfgang, MD, Staudt, Alexander, MD, Weitmann, Kerstin, MSc, Reffelmann, Thorsten, MD, Felix, Stephan B., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.09.2010; Mosby; Elsevier Limited
• Subjects: Accuracy; Acute coronary syndromes; Agreements; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Cardiovascular system; Colleges & universities; Comorbidity; Contrast Media - administration & dosage; Coronary Angiography - adverse effects; Coronary Angiography - instrumentation; Coronary Angiography - methods; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - epidemiology; Coronary vessels; Equipment Design; Feasibility Studies; Fluoroscopy; Humans; Intubation; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Patients; Prospective Studies; Radiation Dosage; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiography, Interventional; Renal Insufficiency - epidemiology; Veins & arteries; Germany; Rotational angiography; Radiodiagnosis; Cardiovascular disease; Circulatory system; Coronary arteriography; Cardiology; Comparative study
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2010.06.011

Background Patient radiation exposure and consumption of contrast medium are considered major risks of diagnostic coronary angiography (CA). Rotation of the C-arm during CA could provide similar diagnostic accuracy and lower radiation exposure and contrast medium consumption. Methods To compare feasibility, safety, diagnostic accuracy, patient radiation exposure, and consumption of contrast medium of rotational CA with the invasive standard technique, intraindividual comparisons of the results obtained by both techniques were performed in 235 patients with an indication for first-time elective CA. In addition to conventional angiography, we performed 2 isocentric radiographic coronary spins with cranial and caudal tilts by 20° around the left coronary artery and 1 strict posteroanterior rotational spin around the right coronary artery. Results In 16 patients, rotational CA was not performed because of safety concerns. In a further 12 patients, image quality of rotational scans was considered inadequate. In the remaining 207 patients, both modes of CA were proven suitable for anonymized, separate analysis by 3 independent cardiologists. Intraindividual comparison of both CA modes revealed a high degree of diagnostic agreement (Cohen κ >0.8 for all cardiologists and for each coronary segment). Contrast medium volume during rotational CA and conventional CA amounted to 31.9 ± 4.5 mL versus 52.2 ± 8.0 mL ( P < .001) and patient radiation exposure amounted to 5.0 ± 2.6 Gy × cm2 versus 11.5 ± 5.5 Gy × cm2 ( P < .001), respectively. Conclusions Rotational CA represents a safe and feasible method in clinical routine. Whereas diagnostic accuracy is similar to the usual conventional mode, consumption of contrast medium and patient radiation exposure are significantly reduced.