Angiography procedure

For patients with NSTE ACS undergoing planned early angiography and revascularization with PCI, UFH, LMWH (enoxaparin), fondaparinux, or bivalirudin should be administered. Therapy should be continued for up to 48 hours for UFH, until the patient is discharged, or a maximum of 8 days for either enoxaparin or fondaparinux, and until the end of the PCI or angiography procedure (or up to 42 hours after PCI) for bivalirudin. 

Other uses of fluoroscopy would have the potential for higher cumulative collar exposures. For example, abdominal interventional and angiography procedures typically use image intensifiers and x-ray field sizes which are larger than those used in a cardiac catheterization laboratory. Depending on the orientation of the primary beam, the scattered radiation from the patient may have greater intensity in these other clinical situations than in a cardiac catheterization laboratory. 

Coronary angiography detects the location and degree of coronary atherosclerosis and is used to evaluate the potential benefit from revascularization procedures. Stenosis of at least 70% of the diameter of at least one of the major epicardial arteries on coronary angiography is indicative of significant IHD. 

Either UFH or LMWH should be administered to patients with NSTE ACS. Therapy should be continued for up to 48 hours or until the end of the angiography or PCI procedure. In patients initiating warfarin therapy, UFH or LMWHs should be continued until the International Normalized Ratio (INR) with warfarin is in the therapeutic range for 2 consecutive days. The addition of UFH to aspirin reduces the rate of death or MI in patients with NSTE ACS.47 Enoxaparin was mentioned as preferred over UFH in the 2002 ACC/AHA clinical practice guidelines, as two large clinical trials found a reduction in the combined endpoint of death, MI, or need for PCI in patients... 

Benzodiazepines are useful as orally administered premedications. They are also used intravenously in doses that produce conscious sedation rather than hypnosis. Sedated patients tolerate unpleasant procedures (e.g., wound repair, bronchoscopy, angiography) while maintaining cardiorespiratory function and the ability to respond to tactile stimulation or verbal commands. 

The current situation is exemplified by a study of clinical staff exposures in cardiac angiography at the Montreal Heart Institute (Renaud, 1992). Extensive measurements of staff exposures were made using thermoluminescent dosimeters (TLDs) for 15,000 procedures in three cardiac catheterization laboratories over a 5 y period (1984 to 1988). The TLDs were located under the protective apron at the waist and at the collar outside and above the apron. Readings were made at three-month intervals, with a minimum reportable value of 0.2 mSv. Average values (in mSv per y) for various groups of staff, based on measurements with TLDs worn at the collar, are given in Table 3.3. 

Our production parameters for this generator are presented. The Xe-122/l-122 combination, a convenient source of a short-lived (3.6m) positron emitting iodine, is also discussed. Recent developments in rapid iodination procedures will broaden the potential applications of this generator. Finally, preliminary investigations of another generator derived radionuclide that may have promise is described. Tellurium-118 (6d) is the parent of the 3.5 minute positron emitter Sb-118 which may be useful for first pass angiography. 

Preprocedural, postprocedural, and at six-month follow-up angiography was performed in at least two orthogonal projections after intracoronary injection of nitrates. Quantitative analyses were performed by an independent core laboratory (Brigham and Women s, Boston, MA, U.S). RVD, minimal luminal diameter (MLD), and degree of stenosis (as percentage of diameter) were measured before dilatation, at the end of the procedure, and at a six-month follow-up. Restenosis was defined as >50% diameter stenosis at follow-up. Late loss was defined as MLD after the procedure minus MLD at follow-up. 

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