[Evaluation of the incidence of radiodermatitis lesions in interventional cardiology]. / Évaluation de l'incidence des lésions de radiodermite en cardiologie interventionnelle.

PURPOSE: The percutaneous coronary interventions use large doses of ionizing radiation, particularly when treating complex lesions. The incidence of radio-induced skin lesions is poorly known. Our goal was to evaluate the frequency of occurrence of such lesions, as well as the factors that may contribute to a high radiation dose. The recommended DAP (dose-area product) cutoff for skin monitoring after percutaneous coronary interventions is 500Gy cm2. PATIENTS AND METHOD: We prospectively studied the incidence of acute (after 5-7 days) and subacute (after 7 days to 6 months) skin lesions following angioplasty with a dose-area product (DAP) ≥200Gy cm2 in patients who underwent coronary angioplasty in our center in 2013. RESULTS: Nine hundred and thirty three consecutive procedures were analyzed, of which 102 with a DAP ≥200Gy cm2. Three patients presented an acute lesion. Two of these three patients also had subacute lesions. Another patient presented only a subacute lesion. 4.82% (95% CI: [0-10]) of the patients with a DAP ≥200Gy cm2 developed radiodermitis lesions, or 0.47% (95% CI: [0-0.9]) of all the patients who underwent angioplasty. The Body Mass Index and the elective (as opposed to energy) procedures were independently associated with a procedure with a DAP ≥200Gy cm2. CONCLUSION: Radiodermatitis lesions occur for 4.82% of patients benefiting from procedures with a DAP ≥200Gy cm2. We suggest the establishment of a DAP threshold for dermal monitoring of patients of 200Gy cm2 per procedure instead of 500Gy cm2.

[Management of high thrombus burden in primary PCI]. / Gestion des charges thrombotiques importantes en angioplastie primaire.

A large thrombus burden is not uncommon in primary percutaneous coronary intervention, and is associated with more frequent complications. The role of intracoronary thrombolysis and glycoprotein IIb/IIIa inhibitors in the management of a large thrombus burden is discussed. The use of thromboaspiration must follow a particular logic and used with rigorous manipulations; the capacities of the protective filters are often exceeded. Stents dedicated to thrombus management can be used. Interest and limits of these stents are developed. Direct stenting should be encouraged, and delayed stenting probably considered for the most important thrombotic burden despite "negative" results in studies.