Congress:
EuroSafe Imaging 2019
Keywords:
Action 4 - Dose management systems, Neuroradiology brain, Emergency, CT, CT-Angiography, Radiation safety, Safety, Cardiac Assist Devices, Acute
Authors:
G. Coban, K. K. Oguz, K. Aytemir, E. B. Kaya, U. Canpolat, C. Eraslan, B. E. Çifçi, M. R. Onur, �. Parlak
DOI:
10.26044/esi2019/ESI-0073
Background/introduction
Implantable cardioverter and ventricular assist devices have significantly improved the quality of life and survival rate of patients with cardiac arrhythmias and cardiac insufficiency (1-2).
Although these devices are crucial for cardiac function,
life-threatening complications related to device itself,
surgical technique and peri and postoperative management (bleeding,
thromboembolic events,
infection…etc) may occur (3-4).
Neurological events may present as a devastating complication of cardiac devices and reduce the life-quality.
The incidence of acute neurological events was reported as ranging between 14% and 47%,
in patients with left ventricular assist device (LVAD) and implantable cardioverter defibrillator (ICD) (5-6).
The common risk factors for acute neurological events include diabetes,
hypertension,
atrial fibrillation,
peripheral vascular diseases and history of past acute neurological events (cerebrovascular events) given in different studies (6,
8).
Ischemic complications secondary to thromboemboli is more frequently encountered than hemorrhagic complications.
Evidence of acute neurological event potency after implantation of ICD and LVAD necessitates appropriate anticoagulation.
Anticoagulation theraphy in order to overcome ischemia risk in these patients group may provoke the hemorrhage as an opposed phenomena after ICD and LVAD implantation (8).
Diagnosis,
management and posttreatment follow-up of patients with acute cerebrovascular events,
especially cerebral ischemia complicated with hemorrhage,
need repetitive cranial computed tomography (CT) scans,
since almost all ICD and LVAD equipments are not compatible with MRI.
The increased utilization of cranial CT enhances radiation exposure and related cancer risk as an important public health (9).
Most studies related to dose reduction and radiation risks had focused on pediatric patients and pregnant women (10).
In this multi-center study,
our goal was to compare the cumulative radiation dose values between patients who underwent repetitive cranial CT imaging after LVAD or ICD implantation.
We also aimed to determine the variability of CT acquisition parameters used in CT examinations after acute neurological event in order to predict a dose reduction plan within the diagnostic limits without affecting the imaging quality.