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Published on: August 28, 2018
Simultaneous computed tomographic angiography of the coronary and radial arteries
Hiroya Tamaoki1, Fuminobu Yoshimachi2, Tsuyoshi Sakurai3
1Radiologic Technologist, Department of Radiology, Higashikani Hospital, 1520 Hiromi, Kani, Gifu, 509-0214, Japan. h.tamaoki@higashikani-hp.jp.
Insights
Simultaneous computed tomographic (CT) angiography of coronary and radial arteries can be performed without increasing contrast medium. This method improves the success rate of radial artery puncture for coronary interventions.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Radiology
Background:
- Radial access is a common approach for coronary interventions.
- Difficulty in radial artery puncture can arise from small vessel size or anatomical variations.
- Pre-procedural anatomical information can enhance the success rate of radial artery puncture.
Purpose of the Study:
- To evaluate a method for simultaneous computed tomographic (CT) angiography of the coronary and radial arteries.
- To achieve this without increasing the volume of contrast medium used.
- To assess the utility of this combined imaging for improving radial access in coronary interventions.
Main Methods:
- Contrast medium was injected intravenously in the right elbow.
- Test scans determined the time to peak contrast concentration in the aorta (TPA) and radial artery (TPR).
- Main scan used a standardized contrast dose (265 mg iodine/kg), with timing based on TPA and TPR.
Main Results:
- The study included 192 patients (mean age 72.0 ± 9.9 years).
- Successful imaging of radial arteries was achieved in 89.6% (right) and 84.9% (left).
- Minimal increase in radiation exposure and no additional contrast medium were required.
Conclusions:
- Simultaneous CT angiography of coronary and radial arteries is feasible without increasing contrast volume.
- This technique provides valuable anatomical information for radial artery access.
- The method is safe, efficient, and aids in planning coronary interventions using radial access.
Abstract:
Our aim was to assess a method of simultaneous computed tomographic (CT) angiography of the coronary and radial arteries without increasing contrast medium usage. Radial access is a standard approach in coronary interventions. However, radial artery puncture is difficult due to the small size of the radial artery and potential unexpected anomaly. If we can obtain anatomical information on the radial artery beforehand, the success rate of radial artery puncture may increase. Simultaneous CT angiography of the coronary and radial arteries without increasing contrast medium usage was planned. Contrast medium was injected in the right elbow vein. Time to peak concentration of contrast medium in the aorta (TPA) and time to peak concentration of contrast medium in the radial artery (TPR) were obtained by the test scan in each patient based on the time-density curve. The main scan was performed using 265 mg iodine/kg of contrast medium. The start time was decided according to TPA and TPR, respectively. This study included 192 cases [age, mean ± standard deviation (SD),72.0 ± 9.9 years]. Mean TPA and TPR were 19.0 ± 2.3(SD) seconds and 34.0 ± 10.0 s, respectively. Clear images of radial arteries were obtained in 89.6% (right) and 84.9% (left). Radiation exposure during cardiac CT angiography (CCTA) and radial artery CT angiography (RCTA) was 269.9 ± 155.6 mGy cm and 31.1 ± 12.3 mGy cm as dose length product, respectively. RCTA immediately following CCTA was safely performed with minimal increase in radiation exposure and no additional contrast medium. These images can help in radial access as well as distal radial access in coronary interventions.
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