TANISAL KAROTİS ARTER ANJİYOGRAFİ VE KAROTİS STENTLEME RADYASYON PARAMETRELERİ AÇISINDAN DEĞERLENDİRİLDİĞİNDE KORONER İŞLEMLERE KIYASLA GÜVENLİ MİDİR?

Giriş: Literatürde tanısal ve/veya girişimsel karotis arter işlemlerinin maruz kalınan radyasyon açısından güvenliğini araştıran yeterli çalışma mevcut değildir. Bu çalışmada günümüzde sayısı giderek artan tanısal ve girişimsel karotis arter işlemlerinin maruz kalınan radyasyon açısından koroner işlemlere kıyasla güvenliği sorgulanmıştır. Gereç ve Yöntem: Toplam 3288 hasta sırasıyla tanısal koroner anjiyografi, koroner bypass’lı (KABG) hastaların tanısal anjiyografisi, koroner anjiyoplasti, tanısal karotis arter anjiyografi ve karotis arter anjiyoplasti olmak üzere 5 gruba ayrılmıştır. Tanısal koroner anjiyografi ile tanısal karotis arter anjiyografi kendi arasında, koroner anjiyoplasti ve karotis arter anjiyoplasti kendi arasında radyasyon parametreleri açısından kıyaslanmıştır. Maruz kalınan radyasyon doz-alan ürünü (Dose-area product, DAP, cGy*cm2), efektif doz (Effective dose, ED, mGy), film kare sayısı (Number of exposure, NoE) ve fluoroskopi süresi (FS, dakika) ile değerlendirilmiştir. DAP radyasyon dozunu göstermede daha kesin bir parametredir ve uzun dönem stokastik riski (karsinogenez ve genetik etkiler) diğer parametrelere göre daha iyi gösterir. Fakat radyasyona ikincil cilt hasarı veya katarak gibi deterministik etkilerigöstermede çok daha zayıftır. ED ise DAP’a göre deterministik etkileri göstermede daha iyi bir parametredir Bulgular: Tanısal koroner anjiyografi ile tanısal karotis arter anjiyografiler kendi arasında radyasyon parametreleri açısından kıyaslandığında her iki grupta DAP açısından fark saptanmazken, FS tanısal karotis arter anjiyografi kolunda, ED ve NoE ise tanısal koroner anjjiyografi kolunda istatiksel olarak anlamlı olacak şekilde yüksek saptanmıştır. Koroner ve karotis arter anjiyoplasti işlemleri kendi arasında radyasyon parametreleri açısından kıyaslandığında karotis arter anjiyoplasti kolunda FS daha uzunken, DAP, ED ve NoE koroner anjiyoplasti kolunda istatistiksel olarak daha yüksek saptanmıştır. Sonuçlar: Tanısal karotis anjiyografisi tanısal koroner anjiyografiye göre stokastik risk açısından benzer riske sahipken, deterministik etkiler açısından daha güvenilirdir. Karotis arter anjiyoplastisi koroner anjiyoplastiye göre ise hem stokastik risk hem de deterministik etkiler açısından daha güvenilir bulunmuştur.

ARE DIAGNOSTIC AND INTERVENTIONAL KAROTID ARTERY PROCEDURES SAFE AS COMPARED TO CORONARY PROCEDURES WHEN ASSESSED ACCORDING TO RADIATION PARAMETERS?

Introduction: There are not enough number of studies addressing the safety issue of radiation exposure with regard to diagnostic and/or interventional carotid artery procedures in the English literature. The present study assessed the safety issue of diagnostic and/or interventional carotid artery procedures with regard to radiation exposure as compared to coronary procedures. Material and Method: A total of 3288 patients were classified into 5 groups as diagnostic coronary angiography (Group I), diagnostic coronary angiography of patients with previous coronary artery bypass grafting (Group II), coronary angioplasty (Group III), diagnostic carotid artery angiography (Group IV) and carotid artery angioplasty (Group V). The radiation parameters in Groups I and IV were compared as well as Groups III and V. The radiation exposure was assessed with dose-area product (DAP) expressed in cGY*cm2 , effective dose (ED) expressed in mGy, number of exposures (NoE), and fluoroscopy time (FT) expressed in minutes. DAP is a more precise indicator of radiation exposure and is strongly correlated with the longterm stochastic risk (carcinogenic and genetic effects) of cancer. In contrast, DAP is a poor indicator of the deterministic effect which is the tissue reactions as radiation-induced skin injury and cataract. Briefly, ED is a more reliable parameter to demonstrate the deterministic effects as compared to DAP. Results: There was no significant difference regarding DAP among diagnostic coronary and carotid angiographies, whereas FT was longer in Group IV, and ED and NoE were higher in Group I. When coronary and carotid angioplasty procedures were compared with regard to radiation parameters, FT was longer in Group V, whilst DAP, ED, and NoE were higher in Group III. Conclusion: The stochastic risk was similar between diagnostic carotid and coronary angiographies, whereas diagnostic carotid angiography was safer than diagnostic coronary angiography with regard to deterministic effects. Moreover, carotid angioplasty procedures were safer with regard to both stochastic risk and deterministic effects as compared to coronary angioplasty procedures

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