Abstract
ObjectivesModern 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.MethodsA 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.ResultsEighty-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).ConclusionsThis 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).
Highlights
Endovascular treatment of intracranial aneurysms has become a standard procedure since the International Subarachnoid Aneurysm Trial (ISAT) results confirmed at least equal clinical outcome when compared with neurosurgical approaches [1, 2]
Recommendations on elective endovascular treatment of unruptured intracranial aneurysms (UIAs) are (i) a high technical success and low peri-procedural complication rate, (ii) a reasonable radiation dose in young patients according to the ALARA principle, and (iii) a limited intervention duration, as a prolonged fluoroscopy time is associated with an increased peri-procedural complication rate [16]
We identified a total of 294 patients with either an UIA or ruptured/symptomatic intracranial aneurysm who have been treated endovascularly at our institution between January 2015 and May 2019
Summary
Endovascular treatment of intracranial aneurysms has become a standard procedure since the International Subarachnoid Aneurysm Trial (ISAT) results confirmed at least equal clinical outcome when compared with neurosurgical approaches [1, 2]. As the guidelines for radiation protection have been updated recently [3], observance of diagnostic reference levels (DRLs) in endovascular treatment of intracranial aneurysms has increased in significance. As a consequence, published data on radiation dose often only take into account coil embolisation [11,12,13,14,15] These studies mainly contain interventional data of unselected patients, i.e. patients with both elective and emergency aneurysm treatment (in case of a ruptured and/or symptomatic aneurysm). Recommendations on elective endovascular treatment of UIAs are (i) a high technical success and low peri-procedural complication rate, (ii) a reasonable radiation dose in young patients according to the ALARA (as low as reasonably achievable) principle, and (iii) a limited intervention duration, as a prolonged fluoroscopy time is associated with an increased peri-procedural complication rate [16]
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