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Complex PCI: Understanding Operator Risk and Potential Solutions

Posted by Corindus Staff
October 29, 2015
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The good news for patients is that advances in devices and techniques have enabled interventional cardiologists to treat complex cases, once treated primarily through open heart surgery, through minimally invasive procedures, such as Percutaneous Coronary Intervention (PCI).In addition to of the increasing volume of complex PCIs, adoption of radial access has increased significantly in the United States.

 

As the number of minimally invasive, catheter-based procedures increase, however, so do the health risks to interventional cardiologists and cath lab teams. These procedures use X-ray based imaging (fluoroscopy), which emits ionizing radiation. While it helps visualize the location, movement and placement of catheter devices, fluoroscopy is linked to health issues ranging from the development of cataracts and premature vascular aging to brain tumors.

 

To reduce radiation exposure, the standard protocol is for interventional teams to wear leaded personal protective equipment (PPE). Unfortunately, PPE still exposes interventionalists to a significant amount of scatter radiation and also can lead to serious orthopedic injuries that in some cases, can shorten careers. In fact, spinal injury is so pervasive among interventional cardiologists that it has been dubbed “interventionalist’s disc disease.”

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MRI of nationally recognized interventionalist’s back

 

Compounding the problem, complex cases tend to prolong the amount of time interventional cardiologists stand in with heavy lead aprons. These cases and radial access PCI have also been associated with higher radiation exposure for Interventional cardiologists1.

 

The impact of exposure to chronic, low-level fluoroscopy can be critical. Interventionalists are typically positioned with the left side of their body close to the patient’s chest and X-ray source, leaving their head, neck and body most exposed to scatter radiation, which increases the risk of health problems such as brain tumors. New research also indicates that continued exposure to low-dose ionizing radiation increases cardiovascular risk. Despite these risks, a recent survey found that nearly 30 percent of interventionalists don’t wear dosimeters routinely and almost 20 percent have indicated they don’t use dosimeters for every procedure2.

 

As noted earlier, interventionalists also have high rates of orthopedic injury as a result of standing for long periods of time, combined with the weight of leaded aprons, thyroid collars and other PPE. A Mayo Clinic study revealed that more than half of interventional professionals reported work-related pain, which was significantly higher than non-interventional workers.

 

Technology such as the CorPath Vascular Robotic System has demonstrated its value in protecting the interventional cardiologist from radiation exposure. CorPath’s impact is higlighted in complex and radial PCI, as it enables the operator to perform the procedure while seated at a radiation-shielded interventional cockpit, and enables the staff to position themselves further from the radiation source.  This also negates the need for PPE while seated at the CorPath cockpit, potentially reducing orthopedic stress. Ultimately, CorPath may help extend the years in practice for interventional cardiologists, which would benefit countless patients requiring life-saving treatment.

 

To learn more about operator safety in complex and radial access PCIs, click here to download a free issue brief discussing the matter in further detail. 

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Watch a video of one physician’s experience with chronic orthopedic injury as a result of working in the cath lab.

 

 

1 Pancholy SB, Joshi P, Shah S, et al. Randomized evaluation of vascular entry site and radiation exposure: the REVERE trial. J Am Coll Cardiol Intv. 2015; Epub ahead of print.

2 Klein LW, Tra Y, Garratt KN, Powell W, et al. Occupational health hazards of interventional cardiologists in the current decade: Results of the 2014 SCAI membership survey. Catheter

Cardiovasc Interv. 2015.

  
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