European Heart Journal Advance Access originally published online on February 27, 2008
European Heart Journal 2008 29(7):954-955; doi:10.1093/eurheartj/ehn059
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Radiation exposure and vascular access site: reply
Service de Cardiologie
Hôpital Robert Debré
C.H.U. Reims
France
Tel: +33 3 26 78 70 20
Fax: +33 3 23 78 41 32
Email: camille.brasselet{at}chu-reims.fr
Service de Cardiologie
Hôpital Robert Debré
C.H.U. Reims
France
We gratefully thank Hamon for his careful reading and helpful comments about our manuscript.1
We agree with him that the non-randomized design of the present registry could represent a major methodological issue of this study. However, as mentioned in the manuscript, the special feature of this registry was that operators were blinded to the collection of data, and its purpose is because it was made on the radioprotection team's initiative. We therefore believe that this registry reflects the ‘real world’ practices in term of radiation exposure and use of radial route in the setting of using optimized radiation protection devices, in a mild to moderate trans radial volume centre.
Hamon mentioned first that we ‘globally used TRI <60% of time in our daily practice, at a time when most high volume centres were closer to 90%’. Considering this drawback, Hamon hypothesized that inexperienced trans radial approach operators might have increase operators’ radiation exposure difference between radial and femoral routes. As it is mentioned in the manuscript, we aimed at reporting the experience of operators in a mild to moderate volume centre. We agree with Hamon that performing 
800 percutaneous coronary interventions (PCI) per year in our institution, we cannot extrapolate such results to high-volume centres. In contrast, we believe that most of the centres in France, and may be in Europe, can be related to our experience, growing the potential interest of such findings. Moreover, we understand Hamon's concern about the low-reported trans radial approach rate in this registry. We defined numerous non-criteria inclusion in this registry, i.e. acute coronary syndrome with ST-segment elevation, previous coronary artery bypass grafting, indication of right heart catheterism or other vascular exploration during the same session (i.e., carotid or aortography), repeated CAs and/or PCIs and CAs or PCIs performed by two operators. Exclusion of such patients might have lowered the trans radial approach rate in the present registry, compared with our common statistics (close to 75%). Interestingly, fluoroscopy times in the present registry, using both trans radial and trans femoral approaches, are lower than the data reported in the French experience or the European experience.2 This finding could be considered as reflecting a certain level of trans radial experience of subsequent operators.
Hamon mentioned as well that the side of trans radial access was not specified. We apologize for this mistake. Only right trans radial approach was reported in this study. We agree with him that the left side is more difficult to manage for radioprotection purposes; moreover, it was not relevant to consider such procedures in the study since this approach is barely used in our institution.
Finally, our findings are related to the experience of operators in a mild to moderate volume centre, using a quite old angiography units, in a ‘real world’ setting. We believe that our results are clinically relevant since they presumably reflect practices of centres performing most of the 120.000 PCI per year in France.
References
- Brasselet C, Blanpain T, Tassan-Mangina S, Deschildre A, Duval S, Vitry F, Gaillot-Petit N, Clément JP, Metz D. Comparison of operator radiation exposure with optimized radiation protection devices during coronary angiograms and ad hoc percutaneous coronary interventions by radial and femoral routes. Eur Heart J (2008) 29:63–70.
[Abstract/Free Full Text] - Neofotistou V, Vano E, Padovani R, Kotre J, Dowling A, Toivonen M, Kottou S, Tsapaki V, Willis S, Bernardi G, Faulkner K. Preliminary reference levels in interventional cardiology. Eur Radiol (2003) 13:2259–2263.[CrossRef][Web of Science][Medline]
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