Ankush Gupta1, Sanya Chhikara2, Rajesh Vijayvergiya3, Parag Barwad3, Krishna Prasad3, Rajat Datta4, Nalin K Mahesh5, Preetika Maurya6, Navreet Singh7. 1. Department of Cardiology, Military Hospital Jaipur, Jaipur, India. 2. Vardhman Mahavir Medical College, & Safdarjung Hospital, New Delhi, India. 3. Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, India. 4. Department of Cardiology, Army Hospital Research & Referral, New Delhi, India. 5. Department of Cardiology, Apollo Adlux Hospital, Kochi, India. 6. Base Hospital Delhi Cantt, New Delhi, India. 7. Department of Cardiology, The Air Force Central Medical Establishment, New Delhi, India.
Abstract
Objectives: In this study, we intend to analyze the feasibility and efficacy of very low frame rate fluoroscopy (VLFF) protocol using a combination of 3.8 and 7.5 fps while performing Percutaneous Coronary Intervention (PCI). Methods: A retrospective cohort including 193 patients undergoing PCI under the VLFF protocol (Post-VLFF group) was compared with a retrospective cohort of 133 patients, who underwent PCI prior to implementation of VLFF protocol (Pre-VLFF group). In the Pre-VLFF group, all PCIs were performed using fluoroscopy frame rate of 15 fps. In the Post-VLFF group, 3.8 fps was used to guide catheter engagement, coronary lesion wiring, pre-and post-dilation, and 7.5 fps was used for lesion assessment and stent placement. Increasing use of fluoroscopic storage in place of cineangiography was also encouraged. Cine acquisition in both groups was performed at 15 fps. Primary endpoint was radiation exposure measured by Air Kerma. Secondary endpoints were procedure related outcomes and patient related outcomes (Major Adverse Cardiac Events including all-cause mortality, Target Lesion Failure, Myocardial Infarction, and Stroke). RESULTS: Post-VLFF group showed 74.7% reduction in Air Kerma as compared to Pre-VLFF group (433 ± 27 mGy vs. 1,714 ± 140 mGy; p < 0.0001), with no increase in the fluoroscopy time (15.38 ± 0.98 min Post-VLFF vs. 17.06 ± 1.29 min Pre-VLFF; p = 0.529) and contrast volume (116.5 ± 4.9 ml Post-VLFF vs. 116.7 ± 6 ml Pre-VLFF; p = 0.700). Both groups had comparable procedural success and complications rates as well as incidence of MACE. Conclusions: The very low frame rate fluoroscopy protocol is a feasible, effective, and safe method to significantly reduce the radiation exposure during PCI without any compromise on procedural and patient outcomes.
Objectives: In this study, we intend to analyze the feasibility and efficacy of very low frame rate fluoroscopy (VLFF) protocol using a combination of 3.8 and 7.5 fps while performing Percutaneous Coronary Intervention (PCI). Methods: A retrospective cohort including 193 patients undergoing PCI under the VLFF protocol (Post-VLFF group) was compared with a retrospective cohort of 133 patients, who underwent PCI prior to implementation of VLFF protocol (Pre-VLFF group). In the Pre-VLFF group, all PCIs were performed using fluoroscopy frame rate of 15 fps. In the Post-VLFF group, 3.8 fps was used to guide catheter engagement, coronary lesion wiring, pre-and post-dilation, and 7.5 fps was used for lesion assessment and stent placement. Increasing use of fluoroscopic storage in place of cineangiography was also encouraged. Cine acquisition in both groups was performed at 15 fps. Primary endpoint was radiation exposure measured by Air Kerma. Secondary endpoints were procedure related outcomes and patient related outcomes (Major Adverse Cardiac Events including all-cause mortality, Target Lesion Failure, Myocardial Infarction, and Stroke). RESULTS: Post-VLFF group showed 74.7% reduction in Air Kerma as compared to Pre-VLFF group (433 ± 27 mGy vs. 1,714 ± 140 mGy; p < 0.0001), with no increase in the fluoroscopy time (15.38 ± 0.98 min Post-VLFF vs. 17.06 ± 1.29 min Pre-VLFF; p = 0.529) and contrast volume (116.5 ± 4.9 ml Post-VLFF vs. 116.7 ± 6 ml Pre-VLFF; p = 0.700). Both groups had comparable procedural success and complications rates as well as incidence of MACE. Conclusions: The very low frame rate fluoroscopy protocol is a feasible, effective, and safe method to significantly reduce the radiation exposure during PCI without any compromise on procedural and patient outcomes.
Authors: Donald E Cutlip; Stephan Windecker; Roxana Mehran; Ashley Boam; David J Cohen; Gerrit-Anne van Es; P Gabriel Steg; Marie-angèle Morel; Laura Mauri; Pascal Vranckx; Eugene McFadden; Alexandra Lansky; Martial Hamon; Mitchell W Krucoff; Patrick W Serruys Journal: Circulation Date: 2007-05-01 Impact factor: 29.690
Authors: James W Hansen; Andrew Foy; Torrey Schmidt; Mehrdad Ghahramani; Charles E Chambers Journal: Catheter Cardiovasc Interv Date: 2016-04-28 Impact factor: 2.692
Authors: Alessandro Sciahbasi; Enrico Frigoli; Alessandro Sarandrea; Martina Rothenbühler; Paolo Calabrò; Alessandro Lupi; Francesco Tomassini; Bernardo Cortese; Stefano Rigattieri; Enrico Cerrato; Dennis Zavalloni; Antonio Zingarelli; Paolo Calabria; Paolo Rubartelli; Gennaro Sardella; Matteo Tebaldi; Stephan Windecker; Peter Jüni; Dik Heg; Marco Valgimigli Journal: J Am Coll Cardiol Date: 2017-03-18 Impact factor: 24.094
Authors: Binita Shah; Xingchen Mai; Lakshmi Tummala; Chad Kliger; Sripal Bangalore; Louis H Miller; Steven P Sedlis; Frederick Feit; Michael Liou; Michael Attubato; John Coppola; James Slater Journal: Am J Cardiol Date: 2014-01-15 Impact factor: 2.778
Authors: Min Ku Chon; Kook Jin Chun; Dae Sung Lee; Soo Yong Lee; Jongmin Hwang; Sang Hyun Lee; Ki Won Hwang; Jeong Su Kim; Young Huyn Park; June Hong Kim Journal: Medicine (Baltimore) Date: 2017-07 Impact factor: 1.889