ABSTRACT
The choice of a transradial or transfemoral approach remains a pivotal decision in percutaneous coronary angioplasty. We discuss here the varying criteria leading to a rational choice in the arterial access choice. Since the emergent transradial approach in France has led to a dramatic reduction in local vascular complications, we also discuss the remaining place of femoral approach and the usefulness of femoral percutaneous closure devices.
Subject(s)
Angioplasty, Balloon, Coronary/methods , Catheterization, Peripheral/methods , Angioplasty, Balloon, Coronary/instrumentation , Catheterization, Peripheral/adverse effects , Catheterization, Peripheral/instrumentation , Catheters, Indwelling/adverse effects , Decision Making , Femoral Artery , Hemorrhage/prevention & control , Hemostatic Techniques/instrumentation , Hemostatics/therapeutic use , Humans , Radial ArteryABSTRACT
CONTEXT: Rotational angiography (RA) is a radiological technique that provides multiple views of a vessel for a single injection of contrast. Its significance in the field of coronary angiography is poorly known at present. This study aimed to compare the radiation dose as well as the volume of contrast used during RA compared to standard angiography (SA), and to evaluate its diagnostic precision. METHOD: 78 patients sent for diagnostic coronary angiography were explored using the radial approach. The patients were randomised between RA (3 acquisitions for the left coronary and 1 for the right coronary) or SA. Once a decision to undertake angioplasty had been made following the angiography (RA or SA), the initial study was complemented using the alternative technique (SA or RA) before the angioplasty procedure was performed at a later stage. The severity of the lesions as shown by RA and SA was compared by four experienced coronary angiography operators. RESULTS: 65 patients (mean age 61+/-10 years--mean BMI 26+/-4 Kg/m2) underwent complete RA+SA investigation. The total x-ray dose used during ciné-angiography, the dose received by the patient, and the volume of contrast were significantly reduced in the RA group compared to the SA group (-25%; -36%; -33% respectively). An evaluation of the severity of the stenoses was performed on 168 arterial segments. There was a significant correlation between the two techniques (R=0.95--p<0.001) and the intra-observer variability was non significant (3.7+/-6.8%--p=NS). CONCLUSIONS: Rotational angiography allows the radiation dose and the volume of contrast to be reduced, while retaining a diagnostic precision similar to that of standard angiography.
