Impact of an extension tube on operator radiation exposure during coronary procedures performed through the radial approach

SummaryBackgroundOperator radiation exposure is high during coronary procedures. The radial access decreases the rate of local vascular complications but increases operator radiation exposure. As the X-ray exposure is related to the distance between the operator and the radiation source, the use of an extension tube between the proximal part of the coronary catheter and the ‘injection device’ might decrease operator radiation exposure.AimsTo demonstrate that the use of an extension tube during coronary procedures performed through the radial approach decreases operator radiation.MethodsOverall, 230 patients were included consecutively and randomized to procedures performed with or without an extension tube. Radiation exposure measures were obtained using two electronic dosimeters, one under the lead apron and the other exposed on the physician's left arm.ResultsA non-significant trend towards lower left-arm operator exposure was noted in the extension tube group (28.7±31.0μSv vs 38.4±44.2μSv, p=0.0739). No significant difference was noted according to the type of procedure. Radiation levels were low compared with the series published previously and decreased for each operator during the study.ConclusionThe use of an extension tube did not reduce operator radiation exposure during procedures performed through the radial approach. However, physician awareness was increased during the study due to the use of an exposed electronic dosimeter. The use of exposed electronic dosimeters could therefore be recommended to allow operators to improve their protection techniques

ETUDE DES EFFETS DE L'IRRADIATION ENDOVASCULAIRE POUR LA PREVENTION DE LA RESTENOSE (MISE AU POINT D'UN MODELE EXPERIMENTAL D'ANGIOPLASTIE ET IMPLANTATION D'UNE ENDOPROTHESE CHEZ LE LAPIN)

DIJON-BU Médecine Pharmacie (212312103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Intramural neovascularization and haemorrhages are major long-term effects of intravascular gamma-radiation after stenting.

International audienceStructural changes that might influence the structural integrity of the vessel in response to intravascular brachytherapy (IVB) and stenting were examined, focus being on the importance of neovascularization in rabbit stented arteries. Stents were implanted in the infrarenal aortas of rabbits, immediately followed by gamma IVB or a sham radiation procedure, and the arteries harvested at 6 months. Labelling for von Willebrand factor showed an increase in adventitial and medial neovascularization in irradiated versus control arteries group (5.04+/-0.89 versus 1.51+/-0.23 mm(-2), respectively; p=0.004). Moreover, intramedial haemorrhages (free hemosiderin deposition) and inflammation (macrophages) were only observed in irradiated arteries. No significant change in expression of matrix metalloproteinase 1, 2 or 3 was observed between the irradiated and control group while collagen content decreased in the irradiated versus the control group (10.05%+/-1.48% versus 31.92%+/-3.12%, respectively; p<0.001). The study supports the hypothesis that IVB associated with stenting induces late deleterious effects on the medial layer, characterized by formation of intramural neovessels, haemorrhages and a decrease in collagen content