Comparación de angiografía coronaria rotacional de doble eje (XPERSWING) frente a técnica convencional en la práctica habitual

doi:10.1016/j.recesp.2011.12.014

Revista Española de Cardiología

Volume 65, Issue 5, May 2012, Pages 434-439

https://doi.org/10.1016/j.recesp.2011.12.014 Get rights and content

Resumen

Introducción y objetivos

La coronariografía es la técnica de elección para estudiar la enfermedad coronaria. El estudio con esta técnica requiere varias proyecciones ortogonales. La angiografía rotacional es una nueva técnica que realiza una rotación del tubo de rayos alrededor del paciente sobre un doble eje que permite la visualización desde diferentes ángulos de cada coronaria con una única inyección de contraste. El objetivo es comparar la angiografía convencional (A) con la angiografía rotacional (B) analizando dosis de radiación, cantidad de contraste administrado y tiempo de procedimiento, tanto en el procedimiento diagnóstico como en el terapéutico.

Métodos

Estudio prospectivo de 104 pacientes consecutivos aleatorizados a ambos grupos.

Resultados

Encontramos reducción significativa de contraste (A frente a B, 93,1 ± 41,7 frente a 50,9 ± 14,7 ml; p < 0,0001) y de dosis de radiación (27,6 ± 11,5 frente a 18 ± 6,4 mGycm²; p < 0,0001). Hubo un aumento significativo en el tiempo de procedimiento diagnóstico. Sin embargo, cuando analizamos a los últimos 50 pacientes, desaparecen las diferencias en el tiempo de procedimiento, probablemente debido a la curva de aprendizaje. Se realizó angioplastia a 29 pacientes del grupo A y 28 del grupo B, en el que se mantuvo la reducción de contraste (A frente a B, 335,1 ± 192,1 frente a 238,5 ± 114,4 ml; p = 0,02).

Conclusiones

La angiografía rotacional permite una reducción significativa de la dosis de radiación y la cantidad de contraste administrado en procedimientos diagnósticos respecto a la angiografía convencional. En los pacientes a los que se realiza intervencionismo percutáneo, la reducción de contraste persiste significativamente.

Abstract

Introduction and objectives

Coronary angiography is the gold standard for the study of coronary artery disease. This technique requires several orthogonal projections. Rotational angiography is a new technique which involves pre-set rotation of the X-ray tube around the patient and allows visualization of each coronary artery in different views, using a single contrast injection. The purpose of this study was to compare conventional coronary angiography (A) vs rotational angiography (B), focusing on radiation dose, amount of contrast administered, and total procedure time for both diagnostic and therapeutic percutaneous coronary interventions.

Methods

Prospective study of 104 consecutive patients undergoing coronary angiography who were randomized to one of these techniques.

Results

We found a significant reduction in the amount of contrast administered (A vs B, 93.1 [41.7] vs 50.9 [14.7] mL; P<.0001) and radiation exposure (27.6 [11.5] vs 18 [6.4] mGycm²; P<.0001). A significant increase in total procedure time was noted in the rotational angiography arm. However, when only the last 50 patients were analyzed, we found no difference in procedure time between the groups, probably related to the learning curve of the operators. Angioplasty was performed in 29 patients in group A and 28 patients in group B. Contrast reduction was maintained in the rotational angiography group compared to the conventional technique (A vs B, 335.1 [192.1] vs 238.5 [114.4] mL; P=.02).

Conclusions

The rotational angiography technique leads to a significant decrease in radiation exposure and contrast dose administered for diagnostic procedures when compared to conventional coronary angiography. In patients who undergo percutaneous coronary intervention, contrast reduction remains significant.

Full English text available from: www.revespcardiol.org

Section snippets

Introducción

La coronariografía es la técnica de referencia para el estudio de la enfermedad coronaria. La técnica convencional requiere proyecciones estándar ortogonales, con un mínimo de 3-4 para la coronaria izquierda y 2 para la derecha.

Existen importantes limitaciones inherentes a la valoración con una proyección fija y en dos dimensiones de algo que realmente tiene tres dimensiones¹. La eficacia y la seguridad de la angiografía convencional dependen de la curva de aprendizaje, la capacidad de decisión

Objetivos

El objetivo principal es determinar si la angiografía rotacional permite el estudio de la enfermedad coronaria disminuyendo la cantidad de contraste administrado con respecto a la técnica convencional en la práctica habitual. Objetivo específico: determinar la cantidad de contraste administrado (ml) a los pacientes que se someten a coronariografía diagnóstica con técnica rotacional (XPERSWING) frente a técnica convencional. Objetivos secundarios: determinar la cantidad de contraste administrado

Resultados

Se aleatorizó a 110 pacientes de febrero a abril de 2009; se excluyó del estudio a 6 pacientes (2 por inestabilidad en el catéter, 1 por caída de la presión por lesión de tronco coronario y 1 porque tenía salida independiente de descendente anterior y circunfleja). Por lo tanto se analizó a 104 pacientes, 52 en el grupo de angiografía convencional y 52 en el grupo de angiografía rotacional.

Las características de los pacientes se reflejan en la tabla 1. No hubo diferencias en las características

Discusión

Varios estudios han comparado la angiografía rotacional como técnica eficaz para el diagnóstico de enfermedad coronaria, y no es inferior a la técnica convencional e incluso es superior para analizar ciertos segmentos (primera diagonal, coronaria derecha distal, descendente posterior y tronco posterolateral), pero es inferior para valorar coronarias muy calcificadas, la circulación colateral y el flujo TIMI¹⁵. En el estudio de Klein et al¹⁸ se realizó a 30 pacientes angiografía mediante técnica

Conclusiones

La angiografía rotacional (XPERSWING) de doble eje permite el estudio de la enfermedad coronaria con la misma eficacia y mayor seguridad para el paciente consiguiendo una reducción significativa del volumen de contraste administrado y la dosis de radiación.

Respecto a la técnica convencional, la angiografía rotacional para el diagnóstico de la enfermedad coronaria supone una reducción del volumen de contraste administrado a los pacientes a los que se realiza intervencionismo coronario.

Con la

Conflicto de intereses

Ninguno.

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Cited by (19)

Is Dual-Axis Rotational Coronary Angiography Radiation Dose Reduction Achievable in a Population with 100% Suspected Coronary Artery Disease? A Randomized Trial
2020, Journal of Medical Imaging and Radiation Sciences
Citation Excerpt :
Normally distributed variables were compared using the Student t-test or Wilcoxon test for nonparametric and not normally distributed using the Mann–Whitney test. According to previous studies, radiation dose reduction (55%) and contrast volume reduction using DARCA (57%) [11–13], and the possible effect of acquisitions besides DARCA in them, we estimated that 250 subjects per group would be necessary to detect a 25% reduction in radiation dose with DARCA, with a power of 90%, level of significance of 5%, and 5% of loss of information. A P-value of <.05 (two-sided) was considered statistically significant.
Previous studies have shown a reduction in radiation dose and contrast volume using dual-axis rotational coronary angiography (DARCA), but this has not been replicated in a population with 100% coronary artery disease (CAD).
To find if DARCA dose reduction is achievable in this population, we sought to compare the radiation dose, contrast volume, and procedure time between DARCA and conventional coronary angiography (CCA) techniques in a setting characterized by a prevalence of 100% suspected coronary artery disease.
An all-comer, prospective, randomized, open-label trial was conducted. Cine acquisition dose–area product (DAP), cumulative air kerma (AK), effective dose (E), fluoroscopic time, contrast volume, AK, cine acquisition DAP (CADAP), fluoroscopic DAP (F-DAP), and total DAP were compared between DARCA and CCA groups.
We included 503 consecutive patients with suspected CAD. 252 were assigned to DARCA and 251 to CCA. Stable coronary artery disease was reported in 465 cases and non-ST elevation acute coronary syndrome in 38. Mean age: 61.88 ± 11.2 years, male gender 70.2%. DARCA arm patients showed lower total E dose (6.85 [4.55–10.83] vs. 7.91 [5.58–11.94] Sv; P = .0023), and cine E (3.00 [2.00–4.00] vs. 4.00 [3.00–5.00] Sv; P < .0001). Total DAP was also lower (40.3 [26.8–63.7] vs. 46.5 [32.8–70.2] Gycm²; P = .0023), as a consequence of a lower CADAP (16.3 [10.5–22.9] vs. 23.4 [17.4–32.0] Gycm²; P < .0001), with lower AK (367 [248–1497] vs. 497 [381–1827] mGy; P < .0001), with less contrast medium used (90 [60.0–106.0] vs. 100 [75.0–120.0] mL; P = .014).
In a population with 100% suspected coronary artery disease, DARCA provides accurate information required in CAD, is safe, and results in a significant decrease in contrast material volume and radiation dose compared with CCA. The required extra projections did not neutralize the DARCA radiation dose and contrast volume reduction achievements.
Des études antérieures ont montré une réduction de la dose de rayonnement et de la quantité de volume de contraste en utilisant DARCA, mais cela n'a pas été reproduit dans une population avec 100% de maladie coronarienne (CAD).
Pour déterminer si une réduction de la dose avec DARCA est réalisable dans cette population, nous cherché à comparer la dose de rayonnement, le volume de contraste et le temps de procédure entre angiographie coronaire rotationnelle à deux axes (DARCA) et la technique coronaire conventionnelle d'angiographie (CCA) dans un environnement caractérisé par une prévalence de 100% de suspicion de maladie coronarienne.
essai randomisé, ouvert à tous. Ciné acquisition dose area produit (DAP), cumulatif Air Kerma (AK), dose efficace (E), fluoroscopique temps, volume de contraste, AK, DAP d'acquisition de ciné (CADAP), DAP fluoroscopique (F-DAP) et le DAP total a été comparé entre les groupes DARCA et CCA.
Nous avons inclus 503 patients consécutifs avec suspicion de CAD. 252 affectés à DARCA et 251 au CCA. Maladie coronarienne stable dans 465 cas et syndrome coronarien aigu sans élévation du segment ST dans 38 cas. Âge moyen: 61,88 ± 11,2 ans, sexe masculin: 70,2%. Les patients du bras DARCA ont présenté une dose totale d'E inférieure (6,85 [4,55–10,83] contre 7,91 [5,58–11,94] Sv; P = ,0023), et ciné E (3,00 [2,00–4,00] contre 4,00 [3,00–5,00] Sv; P < ,0001). Le DAP total était également plus faible (40,3 [26,8–63,7] contre 46,5 [32,8–70,2] Gycm ²; P = ,0023), en raison d'une baisse du CADAP (16,3 [10,5-22,9] contre 23,4 [17,4–32,0] Gycm ²; P < ,0001), avec AK inférieur (367 [248–1497] contre 497 [381–1827] mGy; P < ,0001), avec moins de produit de contraste utilisé (90 [60,0–106,0] contre 100 [75,0–120,0] mL; P = ,014).
dans une population avec 100% de suspicion de maladie coronarienne, DARCA fournit les informations précises requises en CAO, est sûre et se traduit par une diminution significative du volume de produit de contraste et de la dose de rayonnement par rapport à CCA. Les projections supplémentaires requises n'ont pas neutralisé la dose de rayonnement DARCA et réalisations de réduction du volume de contraste.
Imaging techniques for the reduction of ionising radiation
2020, Revista Colombiana de Cardiologia
El uso de radiación ionizante en intervencionismo ha tenido un aumento exponencial en los últimos años. Es así como ha generado diagnósticos más precisos y la posibilidad de llevar a cabo intervenciones mínimamente invasivas, pero todo esto a expensas del aumento en la dosis de irradiación para poder obtener una imagen adecuada, nítida y precisa. A su vez, los procedimientos de alta complejidad son dispendiosos y el tiempo de utilización de radiación ionizante es mayor, con lo cual se causan daños en el ADN que incrementan el riesgo de desarrollar cáncer tanto en el paciente como en el intervencionista y el personal asistencial. Por consiguiente, es necesario contar con los mecanismos suficientes para disminuir la radiación ionizante a niveles mínimos, sin perder la capacidad de obtener una imagen adecuada que permita realizar los procedimientos exitosamente.
Este documento se enfoca en explicar técnicas de imagen que ayudan a disminuir la dosis efectiva de radiación ionizante sin modificar la calidad de la imagen.
The use of ionising radiation in interventional studies has increased exponentially in the last few years. It has also provided more accurate diagnoses and the possibility of performing minimally invasive interventions, but all of this at the expense of increasing the radiation dose in order to obtain a suitable, clear, and accurate image. Furthermore, the high complexity procedures are costly, and the time of using ionising radiation is longer. This, in turn, leads to damaging DNA, which increases the risk of developing cancer in the patient, as well as the interventionist, and healthcare staff. For this reason, it is essential to have sufficient mechanisms in order to reduce the ionising radiation to minimum levels, without losing the capacity to obtain an adequate image that enables the procedures to be carried out successfully.
This article focuses on describing imaging techniques that help to decrease the effective dose of ionising radiation without changing the quality of the image.
Prospective evaluation of the development of contrast-induced nephropathy in patients with acute coronary syndrome undergoing rotational coronary angiography vs. conventional coronary angiography: CINERAMA study
2018, Nefrologia
La angiografía coronaria rotacional (ACR) permite reducir la cantidad de contraste administrado y puede prevenir el desarrollo de nefropatía inducida por contraste (NIC) durante los procedimientos coronarios invasivos. El objetivo del estudio es evaluar el impacto de la ACR en la aparición de NIC (aumento de creatinina ≥0,5 mg/dL o ≥25%) tras un síndrome coronario agudo.
De abril a septiembre de 2016 se seleccionaron prospectivamente pacientes con síndrome coronario agudo remitidos para coronariografía diagnóstica con posibilidad de angioplastia ad hoc, que fueron estudiados con ACR o angiografía coronaria convencional (ACC) según criterio del operador. Se compararon la NIC (variable de valoración primaria), variables analíticas, angiográficas y clínicas.
De 235 pacientes reclutados, 116 pacientes fueron estudiados con ACR y 119 pacientes con ACC. El grupo de ACR presentaba mayor edad (64,0 ± 11,8 vs. 59,7 ± 12,1 años; p = 0,006), más mujeres (44,8 vs. 17,6%; p < 0,001) y peor filtrado glomerular estimado (76 ± 25 vs. 86 ± 27 mL/min/1,73 m²; p = 0,001), con menos angioplastias (p < 0,001). Asimismo, el grupo de ACR recibió menos contraste (113 ± 92 vs. 169 ± 103 mL; p < 0,001), diferencias que se mantuvieron en los procedimientos diagnósticos (54 ± 24 vs. 85 ± 56 mL; p < 0,001) y diagnóstico-terapéuticos (174 ± 64 vs. 205 ± 98 mL; p = 0,049). El grupo de ACR presentó menos NIC (4,3 vs. 22,7%; p < 0,001): en el análisis de regresión se objetivó que continuaba relacionándose con menor desarrollo de NIC (riesgo relativo ajustado: 0,868; IC 95%: 0,794-0,949; p = 0,002). No hubo diferencias en las variables clínicas.
La ACR se asoció con menor administración de contraste durante procedimientos coronarios invasivos tras un síndrome coronario agudo, lo que resultó en una menor aparición de NIC.
Rotational coronary angiography (RCA) requires less contrast to be administered and can prevent the onset of contrast-induced nephropathy (CIN) during invasive coronary procedures. The aim of the study is to evaluate the impact of RCA on CIN (increase in serum creatinine ≥0.5 mg/dl or ≥25%) after an acute coronary syndrome.
From April to September 2016, patients suffering acute coronary syndromes who underwent diagnostic coronary angiography, with the possibility of ad hoc coronary angioplasty, were prospectively enrolled. At the operator's discretion, patients underwent RCA or conventional coronary angiography (CCA). CIN (primary endpoint), as well as analytical, angiographic and clinical endpoints, were compared between groups.
Of the 235 patients enrolled, 116 patients received RCA and 119 patients received CCA. The RCA group was composed of older patients (64.0 ± 11.8 years vs. 59.7 ± 12.1 years; p = 0.006), a higher proportion of women (44.8 vs. 17.6%; p < 0.001), patients with a lower estimated glomerular filtration rate (76 ± 25 vs. 86 ± 27 ml/min/1.73 m²; p = 0.001), and patients who underwent fewer coronary angioplasties (p < 0.001) compared with the CCA group. Furthermore, the RCA group, received less contrast (113 ± 92 vs. 169 ± 103 ml; p < 0.001), including in diagnostic procedures (54 ± 24 vs. 85 ± 56 ml; p < 0.001) and diagnostic-therapeutic procedures (174 ± 64 vs. 205 ± 98 ml; p = 0.049) compared with the CCA group. The RCA group presented less CIN (4.3 vs. 22.7%; p < 0.001) compared to the CCA group, and this finding was maintained in the regression analysis (Adjusted relative risk: 0.868; 95% CI: 0.794-0.949; p = 0.002). There were no differences in clinical endpoints between the groups.
RCA was associated with lower administration of contrast during invasive coronary procedures in acute coronary syndrome patients, resulting in lower incidence of CIN, in comparison with CCA.
Comparison of contrast volume, radiation dose, fluoroscopy time, and procedure time in previously published studies of rotational versus conventional coronary angiography
2015, American Journal of Cardiology
Citation Excerpt :
No direct contact with the authors was required to obtain full-text reports. Studies without procedural end points, with only a single rotational coronary artery injection done, based on magnetic resonance imaging, presenting phantom data, and with unclear methods were eliminated leaving a total of 11 studies.7–17 Of these 11 studies, 8 were randomized trials in which patients underwent either RA or CA and 3 were studies in which all patients underwent both RA and CA (Figure 1).
Conventional coronary angiography (CA) with static imaging is limited by the ability to properly select the optimal acquisition angle, vessel foreshortening, and significant radiation exposure. Rotational coronary angiography (RA) acquires coronary images in a multitude of viewing angles during a single injection by means of a moving gantry that rapidly completes a predefined arc. This study compares procedural characteristics of CA and RA. Electronic search of databases such as OVID, Medline, and PubMed was conducted to identify studies comparing procedural characteristics of CA and RA. End points for analysis included contrast volume, radiation dose by dose area product, radiation dose by air kerma, fluoroscopy time, and procedure time. Studies were assessed for quality and bias and were included if they compared coronary imaging of both the right and left coronary systems with CA and RA, included one of the end points of interest, and were in English. A total of 11 studies consisting of 940 patients who underwent RA and 976 who underwent CA were included in the final analysis. Contrast volume, radiation dose by dose area product, and radiation dose by air kerma were all found to be significantly lower with RA compared with CA. There was a statistically significant increase in fluoroscopy time, although this was not clinically significant, and there was no difference in procedure time. RA angiography is a feasible alternative to CA and offers reductions in contrast used and radiation exposure.
Coronary lesions quantification with dual-axis rotational coronary angiography
2013, Cardiovascular Revascularization Medicine
Citation Excerpt :
The subjects were recruited from a pool of patients who were previously scheduled to undergo coronary angiography. The sample size was estimated based on previous studies [3] considering at least 200 consecutive measured lesions. Approval for this study was obtained from the institutional review board of our medical center and an informed consent from all patients.
Coronary angiography (CA) has been the gold standard technique for studying coronary artery disease. It is based on the analysis of bidimensional orthogonal projections that may not be optimal to estimate determinate coronary segments. Rotational angiography “Xperswing” (DARCA) is a new technique that allows the visualization of the coronary arteries from multiple views, with a single contrast injection. The aim of this study is to evaluate the coronary lesions quantification with DARCA.
Quantitative coronary analysis of significant coronary stenosis (> 50%) was performed. Every lesion was measured in two different projections: the “optimal projection”, obtained by DARCA and defined by the operator as the one with a better lesion qualification, and the “standard projection”, corresponding to the usual projection closer to the optimal one in obliquity and angulation. Measures were performed twice and by two independent operators. Intra- and inter-observer correlation was estimated by Kappa index and variables were compared with t Student test (SPSS 14.0).
205 lesions in 147 patients were analyzed. Kappa coefficient intra-observer was 0.80 and 0.86 respectively with an inter-observer correlation index of 0.72. Lesion length and maximal diameter of the vessel were significantly greater in the group of RA. In the segments analysis, calculated length was longer for the first diagonal branch, first marginal obtuse artery, middle circumflex, middle and distal RCA and posterior descending artery, with greater reference diameters for proximal LAD and distal RCA. There were no significant differences for coronary stenosis grade.
RA XperSwing provides a better visualization of coronary arteries improving lesions characterization, with longer measured lesions length and greater vessel diameters, especially in coronary segments with more angulation.
Prospective evaluation of the development of contrast-induced nephropathy in patients with acute coronary syndrome undergoing rotational coronary angiography vs. conventional coronary angiography: CINERAMA study
2018, Nefrologia
Citation Excerpt :
The RCA was performed according to recommendations. In order to obtain optimal quality images by means of RCA, it was decided to perform a 5.8 s rotation in the left coronary artery and the volume injected was 14–2.5 mL/s; for the right coronary artery, it was performed a 4 s rotation and an injection of 10–2 mL/s.19 The procedure of percutaneous coronary intervention ad hoc was left to the discretion of the medical team and it was performed according to the usual clinical practice.
Rotational coronary angiography (RCA) requires less contrast to be administered and can prevent the onset of contrast-induced nephropathy (CIN) during invasive coronary procedures. The aim of the study is to evaluate the impact of RCA on CIN (increase in serum creatinine ≥0.5 mg/dL or ≥25%) after an acute coronary syndrome.
From April to September 2016, patients suffering acute coronary syndromes who underwent diagnostic coronary angiography, with the possibility of ad hoc coronary angioplasty, were prospectively enrolled. At the operator's discretion, patients underwent RCA or conventional coronary angiography (CCA). CIN (primary endpoint), as well as analytical, angiographic and clinical endpoints, were compared between groups.
Of the 235 patients enrolled, 116 patients received RCA and 119 patients received CCA. The RCA group was composed of older patients (64.0 ± 11.8 years vs. 59.7 ± 12.1 years; p = 0.006), a higher proportion of women (44.8 vs. 17.6%; p < 0.001), patients with a lower estimated glomerular filtration rate (76 ± 25 vs. 86 ± 27 ml/min/1.73 m²; p = 0.001), and patients who underwent fewer coronary angioplasties (p < 0.001) compared with the CCA group. Furthermore, the RCA group, received less contrast (113 ± 92 vs. 169 ± 103 ml; p < 0.001), including in diagnostic procedures (54 ± 24 vs. 85 ± 56 ml; p < 0.001) and diagnostic-therapeutic procedures (174 ± 64 vs. 205 ± 98 ml; p = 0.049) compared with the CCA group. The RCA group presented less CIN (4.3 vs. 22.7%; p < 0.001) compared to the CCA group, and this finding was maintained in the regression analysis (Adjusted relative risk: 0.868; 95% CI: 0.794–0.949; p = 0.002). There were no differences in clinical endpoints between the groups.
RCA was associated with lower administration of contrast during invasive coronary procedures in acute coronary syndrome patients, resulting in lower incidence of CIN, in comparison with CCA.
La angiografía coronaria rotacional (ACR) permite reducir la cantidad de contraste administrado y puede prevenir el desarrollo de nefropatía inducida por contraste (NIC) durante los procedimientos coronarios invasivos. El objetivo del estudio es evaluar el impacto de la ACR en la aparición de NIC (aumento de creatinina ≥0,5 mg/dL o ≥25%) tras un síndrome coronario agudo.
De abril a septiembre de 2016 se seleccionaron prospectivamente pacientes con síndrome coronario agudo remitidos para coronariografía diagnóstica con posibilidad de angioplastia ad hoc, que fueron estudiados con ACR o angiografía coronaria convencional (ACC) según criterio del operador. Se compararon la NIC (variable de valoración primaria), variables analíticas, angiográficas y clínicas.
De 235 pacientes reclutados, 116 pacientes fueron estudiados con ACR y 119 pacientes con ACC. El grupo de ACR presentaba mayor edad (64,0 ± 11,8 vs. 59,7 ± 12,1 años; p = 0,006), más mujeres (44,8 vs. 17,6%; p < 0,001) y peor filtrado glomerular estimado (76 ± 25 vs. 86 ± 27 mL/min/1,73 m²; p = 0,001), con menos angioplastias (p < 0,001). Asimismo, el grupo de ACR recibió menos contraste (113 ± 92 vs. 169 ± 103 mL; p < 0,001), diferencias que se mantuvieron en los procedimientos diagnósticos (54 ± 24 vs. 85 ± 56 mL; p < 0,001) y diagnóstico-terapéuticos (174 ± 64 vs. 205 ± 98 mL; p = 0,049). El grupo de ACR presentó menos NIC (4,3 vs. 22,7%; p < 0,001): en el análisis de regresión se objetivó que continuaba relacionándose con menor desarrollo de NIC (riesgo relativo ajustado: 0,868; IC 95%: 0,794-0,949; p = 0,002). No hubo diferencias en las variables clínicas.
La ACR se asoció con menor administración de contraste durante procedimientos coronarios invasivos tras un síndrome coronario agudo, lo que resultó en una menor aparición de NIC.

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Artículo originalComparación de angiografía coronaria rotacional de doble eje (XPERSWING) frente a técnica convencional en la práctica habitualComparison of Dual-Axis Rotational Coronary Angiography (XPERSWING) Versus Conventional Technique in Routine Practice

Resumen

Introducción y objetivos

Métodos

Resultados

Conclusiones

Abstract

Introduction and objectives

Methods

Results

Conclusions

Section snippets

Introducción

Objetivos

Resultados

Discusión

Conclusiones

Conflicto de intereses

Am J Med

Kidney Int

J Am Coll Cardiol

Rev Esp Cardiol

Rev Esp Cardiol

Am Heart J

A novel dual-axis rotational coronary angiography evaluation of coronary artery disease—case presentation and review

Clin Cardiol

Our preoccupation with coronary luminology. The dissociation between clinical and angiographic findings in ischemic heart disease

Circulation

Coronary angiogram interpretation. Interobserver variability

JAMA

Incidence and prognostic importance of acuterenal failure after percutaneous coronary intervention

Circulation

Artículo original
Comparación de angiografía coronaria rotacional de doble eje (XPERSWING) frente a técnica convencional en la práctica habitualComparison of Dual-Axis Rotational Coronary Angiography (XPERSWING) Versus Conventional Technique in Routine Practice