Influence of novel X-ray imaging technology on radiation exposure during chronic total occlusion procedures

We assessed whether use of the novel X-ray imaging technology AlluraClarity (Philips Healthcare, Best, The Netherlands) results in a meaningful reduction of radiation exposure for patients during coronary intervention on chronic total occlusions (CTO-PCI) compared to its predecessor Allura Xper (Philips Healthcare, Best, The Netherlands).

Percutaneous coronary intervention on chronic total occlusion causes 2- to 10-fold higher radiation burden on patients and operators compared to standard PCI. To avoid iatrogenic damage to our patients and personnel, all efficient ways to reduce radiation should be identified and implemented.

Radiation exposure of 196 consecutive CTO patients treated in the same laboratory by a single experienced operator (total experience: > 2,500 CTOs, annual experience: > 100 CTOs/year) was analyzed. Ninety-eight CTO-PCIs (n1 ) were performed with the Allura Xper system and 98 patients (n2 ) were treated using AlluraClarity.

The two groups had similar BMI (n1 : mean 28.43 kg/m2 ; n2 : mean 28.41 kg/m2 ), procedure duration (n1 : mean 75.9 min; n2 : mean 70.7 min), and J-CTO scores (n1 : mean 2.99; n2 : mean 2.82). The success rates did not differ (n1 : 86/98 successful). n2 : 87/98 successful). The radiation doses, however, revealed significant differences in kerma area product (KAP; absolute reduction of 34%; n1 : mean 61.5 Gycm2 ; n2 : mean 40.8 Gycm2 ; P < 0.002) and cumulative air kerma (AK; absolute reduction of 30%; n1 : mean 966.8 mGy; n2 : mean 675.9 mGy; P < 0.002).

Use of the novel X-ray imaging technology resulted in a meaningful and significant reduction in patient radiation exposure during complex coronary interventions (CTO-PCI) compared to use of its predecessor. Similar success rates support the operator's subjective impression of similar, and in some cases superior, image quality.