Measurement of Skin Dose and Radiation-Induced Changes in Skin Microcirculation in Chronic Total Occlusion Percutaneous Cardiac Interventions (Cto-Pci)

Abstract

Skin injuries may occur when radiation doses to the skin exceed 2 Gy. This study aimed to measure changes in skin microcirculation in patients undergoing chronic total occlusion percutaneous coronary interventions (CTO-PCI). In 14 patients, peak skin dose (PSD) was estimated with radiographic films and skin microcirculation was assessed with laser speckle contrast imaging (LSCI), before, 1 day after the intervention, and 4–6 weeks later. The mean PSD was 1.8 ± 0.9 Gy. Peak skin microcirculation increased by 12% from 45 ± 6 PU before to 50 ± 9 PU 1 day after the intervention (p = 0.01), and returned to 46 ± 8 PU after 4–6 weeks (p = 0.15). There was no significant correlation between PSD and the change in perfusion, neither 1 day (r = −0.13, p = 0.69) nor 4–6 weeks after the intervention (r = 0.33, p = 0.35). These results suggest that there are no radiation-induced microvascular changes in the skin after CTO-PCI at skin doses below 2 Gy.

Recanalisation of coronary chronic total occlusions

“…A final confirmation of successful haemostasis of the femoral puncture after the use of closure devices with contralateral injection takes advantage of the bilateral approach routinely required for CTOs. With modern X-ray systems the radiation dose for most CTO procedures is far below the 5 Gy threshold where minor skin damage can be expected [122][123][124][125][126][127] . Still, the use of a low frame rate during fluoroscopy and angiography, avoiding too small field of views and too skewed projections, is helpful in reducing stochastic damage, especially for young and/or heavy patients, as well as the operator's dose, a sensitive issue after the recent reduction in the maximal allowed eye dose (20 mSv/year) prompted by the new EU regulations.…”