DARA ‘superior’ to conventional angiography
MedWire News: Dual axis rotational coronary angiography (DARA) may be superior to conventional angiography in the diagnosis of coronary heart disease, an analysis suggests.
The benefits to patients and health providers is obvious, due to the significantly lower doses of radiation and contrast required and the shorter procedure time, report Victor Grech (Mater Dei Hospital, Malta) and colleagues in the journal Catheterization and Cardiovascular Interventions.
Whereas coronary angiography is carried out in multiple, predefined stationary views at different angulations around the patient, in DARA the c-arm rotates around the patient in a preprogrammed single curved trajectory, the researchers explain. This enables the entire coronary artery to be exposed at different angulations.
The trajectory is carried out in one run for both left and right coronary arteries and operates within safe parameters to avoid collision with the patient, staff, and equipment.
Using the DARA system installed at Mater Dei Hospital in Malta, Grech and team investigated whether DARA differs significantly in radiation dose, contrast loads, and procedure time when compared with conventional single and biplane coronary angiography.
The study was conducted between September and December 2010, and involved 463 patients who were referred for investigation of native coronary anatomy, for any indication. Each patient was randomly allocated to one of four imaging groups: monoplane conventional, monoplane DARA, biplane conventional, and biplane DARA.
The findings revealed that DARA was significantly superior to coronary angiography in almost all values measured, including timings and doses.
Compared with conventional biplane angiography, biplane DARA had a 45.6% smaller dose area product (measure of radiation dose), 23.3% shorter fluoroscopy time, 58.2% fewer runs, 49.1% fewer extra views, 12.4% less contrast used, and 15.2% shorter procedure time.
Grech and team point out that an advantage noted by the operators using the DARA is that because of the continuous rotation of the tube, the best viewing position could be noted prior to acquiring the extra runs.
They say that DARA is particularly effective because the coronary arteries are filled with contrast throughout the trajectory and in each image.
"Moreover, each image is unique, unlike the static views generated by conventional angiography that only generates replications and the same image and projection" they add.
The authors caution that the longer runs associated with DARA could theoretically be associated with ischemia, but that in their study, only one patient suffered from transient ischemia during the procedure, which was resolved spontaneously.
They conclude: "DARA may prove to be an important and useful tool in the refinement of diagnostic coronary angiography by reducing patient contrast and radiation doses and reducing procedure time."
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By Piriya Mahendra