Radiation dose and fluoroscopy time of modern endovascular treatment techniques in patients with saccular unruptured intracranial aneurysms
Open Access
- 19 March 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in European Radiology
- Vol. 30 (8), 4504-4513
- https://doi.org/10.1007/s00330-020-06777-x
Abstract
Objectives Modern endovascular treatment of unruptured intracranial aneurysms (UIAs) demands for observance of diagnostic reference levels (DRLs). The national DRL (250 Gy cm2) is only defined for coiling. We provide dosimetric data for the following procedures: coiling, flow diverter (FD), Woven EndoBridge (WEB), combined techniques. Methods A retrospective single-centre study of saccular UIAs treated between 2015 and 2019. Regarding dosimetric analysis, the parameters dose area product (DAP) and fluoroscopy time were investigated for the following variables: endovascular technique, aneurysm location, DSA protocol, aneurysm size, and patient age. Results Eighty-seven patients (59 females, mean age 54 years) were included. Total mean and median DAP (Gy cm2) were 119 ± 73 (89–149) and 94 (73; 130) for coiling, 128 ± 53 (106–151) and 134 (80; 176) for FD, 128 ± 56 (102–153) and 118 (90; 176) for WEB, and 165 ± 102 (110–219) and 131 (98; 209) for combined techniques (p > .05). Regarding the aneurysm location, neither DAP nor fluoroscopy time was significantly different (p > .05). The lowest and highest fluoroscopy times were recorded for WEB and combined techniques, respectively (median 26 and 94 min; p < .001). A low-dose protocol yielded a 43% reduction of DAP (p < .001). Significantly positive correlations were found between DAP and both aneurysm size (r = .320, p = .003) and patient age (r = .214, p = .046). Conclusions This UIA study establishes novel local DRLs for modern endovascular techniques such as FD and WEB. A low-dose protocol yielded a significant reduction of radiation dose. Key Points • This paper establishes local diagnostic reference levels for modern endovascular treatment techniques of unruptured intracranial aneurysms, including flow diverter stenting and Woven EndoBridge device. • Dose area product was not significantly different between endovascular techniques and aneurysm locations, but associated with aneurysm size and patient age. • A low-dose protocol yielded a significant reduction of dose area product and is particularly useful when applying materials with a high radiopacity (e.g. platinum coils).This publication has 22 references indexed in Scilit:
- Safety and efficacy of the Derivo Embolization Device for the treatment of ruptured intracranial aneurysmsJournal of NeuroInterventional Surgery, 2018
- Safety and efficacy of aneurysm treatment with WEB in the cumulative population of three prospective, multicenter seriesJournal of NeuroInterventional Surgery, 2017
- Radiation Exposure during Neurointerventional Procedures in Modern Biplane Angiographic Systems: A Single-Site ExperienceInterventional Neurology, 2017
- WEB-DL Endovascular Treatment of Wide-Neck Bifurcation Aneurysms: Long-Term Results in a European SeriesAmerican Journal of Neuroradiology, 2015
- Silk Flow-Diverter Stent for the Treatment of Intracranial Aneurysms: A Series of 58 Patients with Emphasis on Long-Term ResultsAmerican Journal of Neuroradiology, 2014
- The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT)The Lancet, 2014
- Pipeline for Uncoilable or Failed Aneurysms: Results from a Multicenter Clinical TrialRadiology, 2013
- WEB Device for Endovascular Treatment of Wide-Neck Bifurcation AneurysmsAmerican Journal of Neuroradiology, 2013
- How to set up and apply reference levels in fluoroscopy at a national levelEuropean Radiology, 2006
- International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusionThe Lancet, 2005