Occlusion Type, Number of Recanalization Passages and Dose Program Determine Radiation Dose in Endovascular Stroke...

Identification of independent treatment factors associated with high radiation exposure during endovascular mechanical thrombectomy (EMT) in acute ischemic stroke.

This retrospective analysis included all patients treated by means of EMT during the 2‑year period 2017-2018 in a comprehensive stroke center. The EMT were performed by four internal and three external certified neuroradiologists in a clinic overlapping on call system. Radiation exposure as the dependent variable (dose area product DAP, Gy ⋅ cm²) was dichotomized in < 100 Gy ⋅ cm² and ≥ 100 Gy ⋅ cm². Independent variables were age (< 75 years vs. ≥ 75 years), time of intervention (during vs. beyond workday), treating neuroradiologist (internal vs. external), occlusion type ("mono" vs. "tandem"), reperfusion success (TICI 0-2A vs. TICI 2B/3), recanalization attempts (≤ 2 vs. > 2) and dose protocol (normal dose in 2017 vs. low dose in 2018).

The EMT treatment of 208 patients (111 female, 97 male, mean age 71.6 years) was analyzed. Median DAP was 86.6 Gy ⋅ cm² and could be reduced from 104.8 Gy ⋅ cm² (N = 105 in 2017) to 73.3 Gy ⋅ cm² (N = 103 in 2018) with LD program. Univariable and multivariable binary logistic regression analysis revealed a significantly increased radiation exposure (≥ 100 Gy ⋅ cm²) in tandem occlusion type (P < 0.001), > 2 recanalization attempts (P < 0.001) and normal dose protocol (P = 0.002).

Low dose programs can significantly reduce the radiation exposure in EMT. High radiation exposure is significantly associated with more than two recanalization attempts and in cases of tandem occlusions.