Aims and objectives
International dose reference levels are lacking for mechanical thrombectomy in acute ischemic stroke patients with large vessel occlusions.
We studied whether Radiation Dose reduction Systems (RDS) could effectively reduce exposure and propose achievable levels.
Methods and materials
We retrospectively included consecutive patients treated with thrombectomy on a biplane angiography system (BP) in five international,
high-volume centers between January 2014 and May 2017.
Institutional Review Board approvals were obtained.
procedural and clinical characteristics were assessed.
radiation dose and contrast load were compared between angiography systems with and without RDS.
Multivariate analyses were adjusted according to Bonferroni.
Out of the 1096 thrombectomized patients,
520 (47%) were treated on a BP equipped with RDS.
After multivariate analysis,
RDS significantly reduced DAP [91 vs 140 Gy.cm²,
relative effect 0.74 (CI: 0.66; 0.83),
p<0.001] and air kerma [0.46 vs 0.97 Gy,
relative effect 0.63 (CI: 0.56; 0.71),
p<0.001] with 75th percentile levels of 148 Gy.cm² and 0.73 Gy,
There was no difference in contrast load,
rates of successful recanalization,
Radiation Dose reduction Systems can reduce DAP and air kerma by a third and a half,
without affecting thrombectomy efficacy or safety.
The respective thresholds of 148 Gy.cm² and 0.73 Gy represent achievable levels that may serve to optimize current and future radiation exposure in the setting of acute ischemic stroke treatment.
As technology evolves,
we expect these values to decrease.
Beumer D et al (2015) A randomized trial of intraarterial treatment for acute ischemic stroke.
N Engl J Med 372:11-20 2 Campbell BC,
Kleinig TJ et al (2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection.
N Engl J Med 372:1009-1018 3 Jovin TG,
Cobo E et al (2015) Thrombectomy within 8 hours after symptom onset in ischemic stroke.
N Engl J Med 372:2296-2306 4 Saver JL,
Bonafe A et al (2015) Stent-retriever...