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Using coronary CT angiography for guiding invasive coronary angiography: potential role to reduce intraprocedural radiation exposure

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

We investigated the potential reduction of patient exposure during invasive coronary angiography (ICA) if the procedure had only been directed to the vessel with at least one ≥ 50% stenosis as described in the CT report.

Methods

Dose reports of 61 patients referred to ICA because of at least one ≥ 50% stenosis on coronary CT angiography (CCTA) were included. Dose–area product (DAP) was documented separately for left (LCA) and right coronary arteries (RCA) by summing up the single DAP for each angiographic projection. The study population was subdivided as follows: coronary intervention of LCA (group 1) or RCA (group 2) only, or of both vessels (group 3), or further bypass grafting (group 4), or no further intervention (group 5).

Results

57.4% of the study population could have benefitted from reduced exposure if catheterization had been directly guided to the vessel of interest as described on CCTA. Mean relative DAP reductions were as follows: group 1 (n = 18), 11.2%; group 2 (n = 2), 40.3%; group 3 (n = 10), 0%; group 4 (n = 3), 0%; group 5 (n = 28), 28.8%.

Conclusions

Directing ICA to the vessel with stenosis as described on CCTA would reduce intraprocedural patient exposure substantially, especially for patients with single-vessel stenosis.

Key points

• Patients with CAD can benefit from decreased radiation exposure during coronary angiography.

• ICA should be directed solely to significant stenoses as described on CCTA.

• Severely calcified plaques remain a limitation of CCTA leading to unnecessary ICA referrals.

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Abbreviations

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

CCTA:

Coronary computed tomography angiography

DAP:

Dose–area product

DLP:

Dose–length product

FFR:

Fractional flow reserve

ICA:

Invasive coronary angiography

LCA:

Left coronary artery

PCI:

Percutaneous coronary intervention

RCA:

Right coronary artery

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Institute for Diagnostic and Interventional Radiology, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany

    Christophe T. Arendt, Patricia Tischendorf, Julian L. Wichmann & Thomas J. Vogl

  2. Clinic for Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    Michael Messerli & Simon Wildermuth

  3. Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zürich, Switzerland

    Michael Messerli

  4. Clinic for Cardiology, Medical Department I, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    Lucas Jörg & Niklas Ehl

  5. Clinic for Diagnostic and Interventional Radiology, RWTH University Hospital Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany

    Robin F. Gohmann

  6. RNS Gemeinschaftspraxis GbR, Private Radiology and Radiation Therapy Group, Alte Schmelze 20, 65201, Wiesbaden, Germany

    Ralf W. Bauer

Authors
  1. Christophe T. Arendt
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  2. Patricia Tischendorf
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  3. Julian L. Wichmann
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  4. Michael Messerli
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  5. Lucas Jörg
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  6. Niklas Ehl
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  7. Robin F. Gohmann
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  8. Simon Wildermuth
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  9. Thomas J. Vogl
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  10. Ralf W. Bauer
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Corresponding author

Correspondence to Ralf W. Bauer.

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Guarantor

The scientific guarantor of this publication is Ralf W. Bauer.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Ralf W. Bauer is on the speakers’ bureau of Siemens Healthcare, Bayer Healthcare and GE Healthcare. Julian L. Wichmann received speakers’ fees from Siemens Healthcare and GE Healthcare.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the institutional review board.

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Institutional review board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Arendt, C.T., Tischendorf, P., Wichmann, J.L. et al. Using coronary CT angiography for guiding invasive coronary angiography: potential role to reduce intraprocedural radiation exposure. Eur Radiol 28, 2756–2762 (2018). https://doi.org/10.1007/s00330-018-5317-2

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  • DOI: https://doi.org/10.1007/s00330-018-5317-2

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