Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
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Catheter Cardiovasc Interv · Jan 2006
Randomized Controlled Trial Comparative StudyRandomized comparison of operator radiation exposure during coronary angiography and intervention by radial or femoral approach.
Controversial data have been published on the amount of radiation exposure during radial coronary procedures. We hypothesized that in the current era, high-volume operators with optimal technique would not be exposed to higher radiation doses during radial procedures. A total of 297 patients undergoing cardiac catheterization (195 elective diagnostic coronary angiograms and 102 elective coronary interventions) were prospectively assigned in a random fashion to the radial access (RA) or femoral access (FA). ⋯ This study demonstrates that the radial approach is burdened with a 100% increase in operator radiation exposure during diagnostic coronary catheterization procedures and a 50% increase during coronary interventions, provided that no special devices for radiation protection are used. Measurements of radiation dose, such as fluoroscopy time and dose-area product, substantially underestimate the disproportionate rise in radiation exposure. Special precautions are warranted to improve radiation protection during invasive coronary procedures via the radial approach.
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Catheter Cardiovasc Interv · Jan 2006
Editorial CommentAn alarm for radialists from its evangelist.
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Catheter Cardiovasc Interv · Nov 2005
Comparative StudyIs it safe to perform cardiac catheterizations on adults with congenital heart disease in a pediatric catheterization laboratory?
To determine the complication rate during the catheterization in adults with congenital heart disease (CHD) in a pediatric catheterization laboratory (PCL). ⋯ The complication rate during the catheterization of adults with CHD in a PCL is similar to the complication rate of children with CHD undergoing cardiac catheterization. The older subset of patients are more likely to encounter complications overall. The encountered complications could be handled effectively in the PCL. With screening in place, it is safe to perform cardiac catheterization on most adults with CHD in a PCL.
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Catheter Cardiovasc Interv · Nov 2005
Comparative StudyFeasibility of early emergency room notification to improve door-to-balloon times for patients with acute ST segment elevation myocardial infarction.
An algorithm to lower time from first contact in the field by EMS personnel to in-hospital mechanical reperfusion is described. ECG tracings were telemetered via cellular phone to an emergency room physician, who then activated the cardiac catheterization call team to bypass usual delays seen during ER triage. ⋯ Sixty-six patients (93.0%) had an adequate ECG transmitted to the ER and six patients with ST elevation myocardial infarction were identified. Door-to-balloon times were lowered to 44 +/- 17.4 min, a substantial decrease over historical norms that range from 120 min (25th percentile) to 289 min (75th percentile).
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Catheter Cardiovasc Interv · Sep 2005
ReviewMRI-guided congenital cardiac catheterization and intervention: the future?
Over the last 10 years, a number of technological advances have allowed real-time magnetic resonance imaging to guide cardiac catheterization, including improved image quality, faster scanning times, and open magnets allowing access to the patient. Potential advantages include better soft tissue imaging to improve catheter manipulation and additional functional information to assist with interventional decision-making, all without exposure to ionizing radiation. MRI-guided diagnostic catheterization, balloon dilation, stent placement, valvar replacement, atrial septal defect closure, and radiofrequency ablation all have been shown feasible in animal models. MRI-guided catheterization has the potential to replace the current X-ray-based diagnostic and interventional procedures for children with congenital heart disease, avoiding all radiation exposure while improving soft tissue imaging.