ABSTRACT
Standard coronary angiography [SA] has some limitations and complications. Technology has been developed to perform rotational coronary angiography [RA] that may overcome SA limitations and complications while keeping the diagnostic accuracy. RA is a technique that provides with one contrast injection, a panoramic or dynamic cineangiogram of the coronary tree, during up to 180 rotation of the gantry. The purpose was to compare RA and SA regarding diagnostic accuracy and patient safety. Our study included 20 patients with a clinical indication for diagnostic coronary angiography [CA] at Cardiology Department, El Minia University Hospital. Patients were subjected to: SA [4 fixed projections for LCA and 2 for RCA] and RA [2 projections for LCA [RAO 60- LAO 60- caudal and cranial] and [1 projection for RCA [RAO 30- LAO 90- cranial]]. Acquisition of additional static angiographic projections was done for better diagnostic assessment whenever needed after SA and/or RA. QCA analyses were performed on two views [first from SA and second from RA] showing a significant lesion. Radiation dose [RD], contrast volume [CV], total number of frames [TNF], total number of image acquisitions [TNIA], additional projections [AP], reference vessel diameter [RVD], minimal lumen diameter [MLD], lesion percent stenosis [LPS] and lesion length [LL] were evaluated and compared between the two angiographic techniques. We analyzed 38 lesions. Their distributions were: 19[50%] in LAD, 9[23.68%] in RCA, 7[18.42%] in circumflex and 3 [7.89%] in the diagonals. There were no statistically significant differences between SA and RA derived QCA data in MLD[1.197 +/- 0.651 Vs 1.175 +/- 0.642], RVD[2.8l9 +/- 0.961 Vs 2.752 +/- 0.99], LPS [65.495 +/- 16.225 Vs 64.989 +/- 16.426], and in LL [12.575 +/- 6.392 Vs 12.406 +/- 6.338], p ns for all. At the same time, RA derived QCA data strongly correlated with SA derived QCA data with correlation coefficient, 0.99 1, 0.975, 0.994, and 0.996 respectively. On the other hand, RD was 44% less [245.83 +/- 132.17 Vs. 442.23 +/- 272.55 mGy], CV was 45% lower. [24.28 +/- 10.78 Vs. 43.98 +/- 20.77 ml], TNF was 45% fewer [162 +/- 65.54 vs. 293.21 +/- 142.83], TNIA was 59% lower [1.82 +/- 0.67 vs. 4.46 +/- 1.88], and AP was 82% lower beyond the pre specified protocol [0.21 +/- 0.49 vs. 1.179 +/- 1.249] in the RA compared to the SA technique, p<0.0001 for all. RA-derived QCA has similar diagnostic accuracy and strongly correlates with SA derived QCA. Furthermore, RA has better safety as it leads to a significant reduction in radiation exposure and contrast use. In the future therefore, RA may replace SA and should be compared with MSCT CA in diagnosis of CAD especially if coupled with minimally invasive approaches such as radial access and use of 4 French devices