Skip to main content
Log in

Dual-axis rotational coronary angiography versus conventional coronary angiography: a randomized comparison

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Background

Dual-axis of rotational coronary angiography (RA), with one single cine acquisition during continuous C-arm motion along a pre-described path, is an alternative to conventional coronary angiography (CA). We assessed the performance of RA versus CA in a modern, experienced cath lab setting.

Methods

Sixty-seven patients with suspected coronary artery disease undergoing invasive coronary angiography were randomized to CA (n = 35) or dual-axis RA (n = 32). CA was performed with four left and two right coronary artery acquisitions with manual contrast medium injection. In RA, one cine acquisition each was performed for the left (5 projections) and right coronary artery (3 projections) with a fixed amount of contrast medium applied by a power injector. In both groups, single cine acquisitions in additional angulations were performed to fully interpret the coronary system, if necessary. Procedural parameters and outcome were compared.

Results

Mean age was 63 ± 12 years (64% males). Six additional projections were required in the RA group compared to 13 in the CA group (p = 0.173). Fluoroscopy duration (CA: 3 ± 3 min, RA: 3 ± 2 min, p = 0.748) and dose area product (CA: 1291 ± 761 µGym2, RA: 1476 ± 679 µGym2, p = 0.235) did not differ significantly between both groups. For CA, the amount of contrast medium (42 ± 13 vs. 46 ± 8 ml, p = 0.022) and procedure time (8 ± 5 vs. 11 ± 3 min, p < 0.001) were significantly lower. No major adverse event occurred during hospital stay.

Conclusions

Dual-axis RA represents a feasible and safe alternative method to CA for obtaining coronary angiograms. However, no superiority was observed when performed by an experienced interventionalist with a modern system.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Code availability

Not applicable.

Abbreviations

RA:

Rotational coronary angiography

CA:

Conventional coronary angiography

LAO:

Left anterior oblique

RAO:

Right anterior oblique

References

  1. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ (2020) ESCSD Group ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 41(3):407–477

    Article  Google Scholar 

  2. Ball WT, Sharieff W, Jolly SS, Hong T, Kutryk MJ, Graham JJ, Fam NP, Chisholm RJ, Cheema AN (2011) Characterization of operator learning curve for transradial coronary interventions. Circ Cardiovasc Interv 4(4):336–341

    Article  Google Scholar 

  3. Galbraith JE, Murphy ML, de Soyza N (1978) Coronary angiogram interpretation Interobserver variability. JAMA 240(19):2053–2056

    Article  CAS  Google Scholar 

  4. Maddux JT, Wink O, Messenger JC, Groves BM, Liao R, Strzelczyk J, Chen SY, Carroll JD (2004) Randomized study of the safety and clinical utility of rotational angiography versus standard angiography in the diagnosis of coronary artery disease. Catheter Cardiovasc Interv 62(2):167–174

    Article  Google Scholar 

  5. Raman SV, Morford R, Neff M, Attar TT, Kukielka G, Magorien RD, Bush CA (2004) Rotational X-ray coronary angiography. Catheter Cardiovasc Interv 63(2):201–207

    Article  Google Scholar 

  6. Farshid A, Chandrasekhar J, McLean D (2014) Benefits of dual-axis rotational coronary angiography in routine clinical practice. Heart Vessels 29(2):199–205

    Article  Google Scholar 

  7. Akhtar M, Vakharia KT, Mishell J, Gera A, Ports TA, Yeghiazarians Y, Michaels AD (2005) Randomized study of the safety and clinical utility of rotational vs. standard coronary angiography using a flat-panel detector. Catheter Cardiovasc Interv 66(1):43–49

    Article  Google Scholar 

  8. Gomez-Menchero AE, Diaz JF, Sanchez-Gonzalez C, Cardenal R, Sanghvi AB, Roa-Garrido J, Rodriguez-Lopez JL (2012) Comparison of dual-axis rotational coronary angiography (XPERSWING) versus conventional technique in routine practice. Rev Esp Cardiol (Engl Ed) 65(5):434–439

    Article  Google Scholar 

  9. Giuberti RS, Caixeta A, Carvalho AC, Soares MM, Abreu-Silva EO, Pestana JO, Silva Junior HT, Vaz ML, Genereux P, Fernandes RW (2014) A randomized trial comparing dual axis rotational versus conventional coronary angiography in a population with a high prevalence of coronary artery disease. J Interv Cardiol 27(5):456–464

    Article  Google Scholar 

  10. Yasar AS, Perino AC, Dattilo PB, Casserly IP, Carroll JD, Messenger JC (2013) Comparison of a safety strategy using transradial access and dual-axis rotational coronary angiography with transfemoral access and standard coronary angiography. J Interv Cardiol 26(5):524–529

    Article  Google Scholar 

  11. Morris PD, Taylor J, Boutong S, Brett S, Louis A, Heppenstall J, Morton AC, Gunn JP (2016) When is rotational angiography superior to conventional single-plane angiography for planning coronary angioplasty? Catheter Cardiovasc Interv 87(4):E104–E112

    Article  Google Scholar 

  12. Jin ZG, Bai R, Li Y, Yang Y, Han W, Zhao Q, Zhang L, Liu HL (2020) Comparison of diagnostic accuracy of dual-axis rotational versus standard coronary angiography. Int J Cardiovasc Imaging 36(2):187–195

    Article  Google Scholar 

  13. Eloot L, Bacher K, Steenbeke F, Drieghe B, Gheeraert P, Taeymans Y, Thierens H (2013) Three-dimensional rotational X-ray acquisition technique is reducing patients' cancer risk in coronary angiography. Catheter Cardiovasc Interv 82(4):E419–E427

    PubMed  Google Scholar 

  14. Empen K, Kuon E, Hummel A, Gebauer C, Dorr M, Konemann R, Hoffmann W, Staudt A, Weitmann K, Reffelmann T, Felix SB (2010) Comparison of rotational with conventional coronary angiography. Am Heart J 160(3):552–563

    Article  Google Scholar 

  15. Di Serafino L, Turturo M, Lanzone S, Marano M, Scognamiglio G, Trimarco B, Cirillo P, Esposito G, D'Agostino C (2018) Comparison of the effect of dual-axis rotational coronary angiography versus conventional coronary angiography on frequency of acute kidney injury x-ray exposure time, and quantity of contrast medium injected. Am J Cardiol 121(9):1046–1050

    Article  Google Scholar 

  16. Loomba RS, Rios R, Buelow M, Eagam M, Aggarwal S, Arora RR (2015) Comparison of contrast volume, radiation dose, fluoroscopy time, and procedure time in previously published studies of rotational versus conventional coronary angiography. Am J Cardiol 116(1):43–49

    Article  Google Scholar 

  17. Grech M, Debono J, Xuereb RG, Fenech A, Grech V (2012) A comparison between dual axis rotational coronary angiography and conventional coronary angiography. Catheter Cardiovasc Interv 80(4):576–580

    Article  Google Scholar 

  18. Klein AJ, Garcia JA, Hudson PA, Kim MS, Messenger JC, Casserly IP, Wink O, Hattler B, Tsai TT, Chen SY, Hansgen A, Carroll JD (2011) Safety and efficacy of dual-axis rotational coronary angiography vs. standard coronary angiography. Catheter Cardiovasc Interv 77(6):820–827

    Article  Google Scholar 

  19. Scholz SS, Lauder L, Ewen S, Kulenthiran S, Marx N, Sakhov O, Kauer F, Witkowski A, Vaglimigli M, Wijns W, Scheller B, Bohm M, Mahfoud F (2020) One-year clinical outcomes in patients with renal insufficiency after contemporary PCI: data from a multicenter registry. Clin Res Cardiol 109(7):845–856

    Article  CAS  Google Scholar 

  20. Feldkamp T, Luedemann M, Spehlmann ME, Freitag-Wolf S, Gaensbacher J, Schulte K, Bajrovic A, Hinzmann D, Hippe HJ, Kunzendorf U, Frey N, Luedde M (2018) Radial access protects from contrast media induced nephropathy after cardiac catheterization procedures. Clin Res Cardiol 107(2):148–157

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

Authors

Contributions

MM: conceptualization, investigation, and writing—original draft; JR: investigation, data curation, and formal analysis; MDG: data curation and methodology; FB: data curation and formal analysis; SA: supervision, and writing—review and editing; CS: conceptualization, project administration, investigation, methodology, and writing—review and editing.

Corresponding author

Correspondence to Michaela M. Hell.

Ethics declarations

Conflicts of interest

Nothing to declare.

Availability of data and material

Not applicable.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hell, M.M., Gilg, M.D., Röther, J. et al. Dual-axis rotational coronary angiography versus conventional coronary angiography: a randomized comparison. Clin Res Cardiol 110, 258–269 (2021). https://doi.org/10.1007/s00392-020-01743-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-020-01743-5

Keywords

Navigation