Análise comparativa da exposição radiológica com uso de cateteres pré-moldados versus cateter único em coronariografia por via transradial

Abstract

A considerable amount of patients submmited to coronariography in cath labs aren t instructed about their radiation exposure, although the possible ionizing radiation damage to human organs has been described (from skin necrosis till cancer). Transradial coronariography can be acomplished with the use of a single dedicated catheter (TIG/Terumo^®), designed to engage both coronary arteries or through traditional technique using two Judkins catheters (JR and JL). This trial has the main objective of comparing radiation exposure to patients, through the measurement of fluoroscopy time and variables as air kerma (AK) and dose area product (DAP), during transradial coronariography using TIG and Judkins catheters. Multicentric, randomized (1:1) and prospective trial (180 patients) comparing radiation exposure through fluoroscopy time (min), air kerma (mGy) and dose area product (μGy.m²) with TIG catheter (GI) versus Judkins catheters (GII). Secondary outcomes included contrast volume (mL) and the need to use additional catheters to complete the procedure. The procedure consisted of three right coronary artery projections, five left coronary artery projections and a left ventriculography, performed by three interventional cardiologists with transradial expertise (>500 procedures TR/operator). The following results: TIG catheter demonstrated reduced fluoroscopy time (2.47±1.05 min GI vs. 2.68±1.26 min GII, p=0.01) and non significant reduction of the other variables (AK - 540.9±225.3 mGy GI vs. 577.9±240.1 mGy GII, p=0.34) and (DAP - 3786.7± 1731.7 μGy.m² vs. 4058.0±1735.4 μGy.m² GII, p=0.12). Contrast volume was equal among groups (GI 53.46±10.09 mL vs. GII 55.98±10.43 mL, p=0.13), as well as the need for additional catheters (5.56% GI vs. 4.44% GII, p=1). The TIG catheter was able to reduce radiation exposure to patients submitted to transradial coronariography through significant reduction in fluoroscopy time.