A retrospective analysis conducted in Germany shows that fluoroscopy times and radiation exposure in patients undergoing renal denervation are similar to those in patients undergoing routine diagnostic catheterisation with elective percutaneous coronary intervention but lower than in patients undergoing emergency intervention. The results were showed in a poster presentation at ISET in Miami, USA.
“Ionising radiation carries an oncogenic risk which is linearly related to the dose and is closely related to procedural time. An estimation of the effective dose can be obtained from the measurements of the dose-area product, which is a measure of stochastic risk and a potential quality indicator,” the authors, led by Frank Himmel, Medizinische Klinik II, Universitätsklinikum Schleswig-Holstein, Lübeck, wrote.
The aim of the study was to assess fluoroscopy time, radiation exposure (dose area-product) and contrast dye consumption in patients undergoing renal denervation to treat medically resistant hypertension in comparison to diagnostic catheterisation and percutaneous coronary intervention.
A retrospective analysis of renal denervation therapy and adult cardiac percutaneous procedures (consecutive patients between January to May 2011 undergoing coronary angiography and ventriculography) was carried out to determine procedural characteristics and the dose-area product. The investigators identified four groups: group 1 (n=790, coronary angiography); group 2 (n=141, elective percutaneous coronary intervention in stable patients); group 3 (n=160, emergency percutaneous coronary intervention in acute coronary syndrome patients), group 4 (n=54, patients undergoing renal denervation). Dose-area product meter attached to the X-ray unit was used for the estimation of the radiation dose received by the patient during the procedures. In average renal denervation therapy consisted of 6–9 bilateral ablations spots.
The results showed that in the renal denervation group fluoroscopy time, dose-area product and contrast dye consumption were 10±1sec, 4878±456cGy cm2 and 141±6mL, respectively. In the elective percutaneous coronary intervention, fluoroscopy time was 11±1sec, dose-area product was 7457±421cGy cm2, and contrast dye consumption was 136±5mL. In emergency percutaneous coronary intervention patients, fluoroscopy time was 12±1sec, dose-area product was 9046±482cGy cm2, and contrast dye consumption was 213±6±5mL.
The authors concluded that the radiation dose varies substantially across different types of procedures and up to tenfold within the same procedure. “The enhanced knowledge of radiation dose might help the cardiologist to implement radiation sparing procedures minimising patient and operator radiation hazards in renal denervation,” they wrote.
Results (mean±standard error of the mean)
|
|
Body weight (kg) |
Fluoroscopy time (sec) |
Dose-area product (cGy cm2) |
CDC (mL)
|
|
Group 1 (coronary angiography) |
82±1 |
5±0.6 |
3514±99 |
99±1 |
|
Group 2 (elective PCI) |
84±1 |
11±1* |
7457±421* |
136±5* |
|
Group 3 (emergency PCI) |
82±1 |
12±1* |
9046±482*+ |
213±6*+ |
|
Group 4 (renal denervation) |
92±3* |
10±1* |
4878±456* |
141±6* |
* p<0.05 vs. group 1, + p<0.05 vs. group 2
