IMAGE IN CARDIOLOGY

DOI: 10.4244/EIJV11I8A184

Severe consequences of high-dose radiation

Ignacio Sanchez-Perez1*, MD; Alfonso Jurado-Roman1, MD, PhD; Natalia Pinilla-Echeverri1, MD; Manuel Marina-Breysse1, MD; Maria Thiscal Lopez-Lluva1, MD; Antonio Gil-Aguado2, MD; Fernando Lozano-Ruiz-Poveda1, MD; J. Antonio Garrido3, MD

A 58-year-old man was admitted with an anterior myocardial infarction and cardiogenic shock. Severe lesions were found at the left anterior descending artery, the circumflex-marginal bifurcation, and the right coronary artery (chronically occluded) (Figure 1A-Figure 1C). Immediately after primary PCI, a second procedure was required due to stent thrombosis at the circumflex bifurcation previously treated. The overall duration of both procedures was 212 minutes (fluoroscopy: 71 minutes). Eighty-five cine runs were recorded, 47 in the right anterior oblique (RAO) view, 25-35º. The total skin dose was 5.2 gray, 2.5 of them in the same zone irradiated in RAO. After one month, the patient developed a skin lesion at the left scapular region. It progressed to a deep ulcer with bone exposure, needing plastic surgery two years later (Figure 1D-Figure 1I).

Figure 1. Coronary angiography and secondary skin lesions. A-C) Angiogram: three-vessel disease. D-I) Skin lesions: from slight erythema to a deep ulcer with bone exposure.

Cutaneous side effects are the main dose-dependent radiation consequences that are usually unrecognised, misdiagnosed, and under-reported. Their incidence is growing due to an increasing number of procedures and their complexity. For lengthy PCIs some measures should be implemented, namely: avoid high-intensity fluoroscopy mode, record more fluoroscopy images and fewer cine runs, minimise source-to-image distance, modify tube angle regularly and use fewer left anterior oblique angles.

Conflict of interest statement

The authors have no conflicts of interest to declare.

Volume 11 Number 8
Dec 20, 2015
Volume 11 Number 8
View full issue


Key metrics

Suggested by Cory

10.4244/EIJV8I6A101 Oct 26, 2012
Radiation exposure as an occupational hazard
Picano E and Vano E
free

Clinical Research

10.4244/EIJ-D-21-00856 Jul 22, 2022
Trends and predictors of radiation exposure in percutaneous coronary intervention: the PROTECTION VIII study
Stocker TJ et al
free
Trending articles
152.9

Clinical research

10.4244/EIJ-D-20-01125 Oct 20, 2021
An upfront combined strategy for endovascular haemostasis in transfemoral transcatheter aortic valve implantation
Costa G et al
free
47.8

NEW INNOVATION

10.4244/EIJ-D-15-00467 Feb 20, 2018
Design and principle of operation of the HeartMate PHP (percutaneous heart pump)
Van Mieghem NM et al
free
39.1

Clinical research

10.4244/EIJ-D-22-00558 Feb 6, 2023
Permanent pacemaker implantation and left bundle branch block with self-expanding valves – a SCOPE 2 subanalysis
Pellegrini C et al
free
38.95

State-of-the-Art

10.4244/EIJ-D-23-00912 Oct 7, 2024
Optical coherence tomography to guide percutaneous coronary intervention
Almajid F et al
free
X

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

EuroPCR EAPCI
PCR ESC
Impact factor: 7.6
2023 Journal Citation Reports®
Science Edition (Clarivate Analytics, 2024)
Online ISSN 1969-6213 - Print ISSN 1774-024X
© 2005-2024 Europa Group - All rights reserved