BACKGROUND:

Rotational coronary angiography (RA) is an alternative technique to conventional coronary angiography with repeated cine acquisitions in multiple projections. Rotational angiography around a single axis is hampered by limited views. Modern C-arm systems allow rapid dual-axis rotation along freely defined paths that encompass all relevant projections and acquisition during one single injection of contrast medium. The applicability of dual-axis RA for the diagnosis of coronary artery disease and its comparison to conventional coronary angiography were the objective of this study.

METHODS:

A consecutive cohort of 54 patients were scheduled for invasive coronary angiography for suspected coronary artery disease (mean age 64±10years, 63 % male, see table). Patients were subsequently randomized to conventional coronary angiography (n=27, CA group) or dual-axis rotational coronary angiography (n=27, dual axis RA group). Exclusion criteria were acute coronary syndrome, impaired renal function (GFR< 30ml/min), prior bypass surgery and left ventricular ejection fraction ≤ 35%. CA was performed with 4 acquisitions for the left coronary artery and 2 acquisitions for the right coronary artery (CA: left coronary artery: RAO 10° CRAN 0°, CRAN 40° RAO 0°, LAO 40° CAUD 40°, RAO 25° CAUD 25°; right coronary artery: LAO 50° CRAN 0°, RAO 30° CRAN 0°. Contrast was injected manually as needed. In dual-axis RA a second sweep was performed for the left coronary artery to include 4 standard angulations (RAO 10° CRAN 0°, RAO 30° CRAN 30°, CRAN 40° RAO 0°, LAO 40° CAUD 40°) and a second sweep for the right coronary artery to include 3 standard angulations (RAO 30° CRAN 0°, LAO 30° CRAN 20°, LAO 50° CRAN 0°). For dual-axis RA, contrast medium was given by a power injector (right coronary artery: 12 ml with 4 ml/s, left coronary artery: 28 ml with 4 ml/s). In both groups, single cine acquisitions in additional angulations were performed if deemed necessary by the operator to fully interpret the entire coronary system. Procedural parameters including total procedure and fluoroscopy time, dose area product, additional projections and amount of contrast medium were compared between the two groups.

RESULTS:

There were no significant differences between the CA and dual-axis RA group regarding baseline characteristics. Amount of contrast medium (CA: 43±14, RA: 43±12 ml, p=0.41), fluoroscopy duration (CA: 3.6±3, RA: 2.7±1.7 min p=0.98), and dose area product (CA: 1392±833 µGym², RA: 1388±720 µGym², p=0.9) were not significantly different between the CA and RA group. Total procedure was significantly shorter in the CA group (CA: 11±3 min., RA: 8±5 min., p=0.001). In the dual-axis RA group, a total of 5 additional projections (0.2±0.3/patient) were needed for adequate diagnostic accuracy, while in the CA group 12  additional projections (0.4±0.6/patient) were performed (p=0.18). In total 37 high-grade stenoses were diagnosed (CA: 21, 0.8±0.8/patient, RA: 18, 0.7±0.6/patient, p=0.99). Overall 26 PCIs followed the coronary angiography (CA: 12, 0.4±0.5/patient, RA: 14, 0.5±0.5/patient, p=0.6). No MACE (death, myocardial infarction, target vessel PCI, pericardiocentesis or stroke) occurred during the hospital stay. 

CONCLUSION: