Radiation Dose Reduction in Mechanical Thrombectomy: Single Versus Dual-Operator Approach

Area of Science:

• Neurology
• Interventional Neuroradiology
• Vascular Surgery

Background:

• The impact of operator numbers on mechanical thrombectomy (MT) outcomes for acute ischemic stroke is not well-established.
• Optimizing procedural efficiency and patient safety in MT is crucial for stroke centers.

Purpose of the Study:

• To evaluate the effect of single versus dual operators on procedure time, radiation dose, and angiographic success in MT for acute ischemic stroke.
• To compare key performance indicators between single- and dual-operator MT workflows.

Main Methods:

• Retrospective cohort study of 285 patients undergoing MT for large-vessel occlusion.
• Patients were categorized into single-operator (n=157) and dual-operator (n=128) groups.
• Primary endpoints: procedure time and radiation dose (total Kerma-Area Product). Secondary endpoints: reperfusion rates (TICI ≥ 2b, TICI 3) and first-pass success (FPS).

Main Results:

• Dual-operator MT showed significantly shorter procedure times (52.5 vs. 85.0 min) and lower radiation doses (total PKA).
• Higher successful reperfusion (TICI ≥ 2b: 80.5% vs. 64.3%) and complete reperfusion (TICI 3: 76.6% vs. 58.5%) were observed in the dual-operator group.
• First-pass success was more frequent (60.0% vs. 44.5%) with fewer passes (1.66 vs. 2.00) in dual-operator procedures.

Conclusions:

• Dual-operator mechanical thrombectomy enhances procedural efficiency and reduces radiation exposure for acute ischemic stroke patients.
• This approach is associated with superior angiographic outcomes, including higher reperfusion and first-pass success rates.
• Findings support the dual-operator model for optimizing stroke center workflows and workforce planning.