Using radial access for PCI or coronary angiography does not increase a patient’s risk of higher radiation exposure, according to a study published in the October issue of Circulation: Cardiovascular Interventions. But some clinical factors may.
Ronal Delewi, MD, of the Academic Medical Center at the University of Amsterdam in The Netherlands, and colleagues used the Swedish Coronary Angiography and Angioplasty Registry to evaluate all PCI and coronary angiography procedures performed between 2008 and 2012 at five PCI centers. They wanted to look at the association between clinical, angiographic and procedural characteristics and radiation exposure as well as access approach. They measured radiation exposure to patients using dose-area product (DAP) measured as Gy.cm2.
Delewi et al identified 10,819 coronary angiography and 9,850 PCI procedures. Radial access was the preferred approach, at 59 percent; 4 percent of the radial access cases converted to femoral.
Based on their analysis, the factors associated with the highest risk of radiation exposure were high body mass index (BMI), a history of CABG, chronic total occlusion (CTO) lesions, and two, three or four treated lesions.
In patients undergoing PCI, median radiation exposure was lower with radial procedures, at 44 Gy.cm2 compared with 48 Gy.cm2 for femoral access. The median radiation exposure was 73 Gy.cm2 for radial vs. 79 Gy.cm2 for femoral. The median radiation exposure for CABG patients was 31 Gy.cm2, regardless of access route.
Given the circumstances, physicians will not be able to modify these identified characteristics before performing coronary angiography or PCI but they now will be able to inform patients about the potential risks.
“Also, when treating complex or CTO lesions, especially in patients with high BMI or previous CABG, radiation management can be incorporated into preprocedure planning as well as in defining maximum levels that could guide physicians in decision making during the procedure accordingly,” Delewi et al added.
Previous findings on patient exposure to radiation during procedures using the radial access have been conflicting. Some studies included operators who were not as experienced with the radial approach, patient populations that were not well matched and indirect measures for radiation exposure, they wrote.