Abstract
PurposeTo determine the radiation exposure in endovascular stroke treatment (EST) of acute basilar artery occlusions (BAO) and compare it with radiation exposure of EST for embolic middle cerebral artery occlusions (MCAO).MethodsIn this retrospective analysis of an institutional review board−approved prospective stroke database of a comprehensive stroke center, we focused on radiation exposure (as per dose area product in Gy × cm2, median (IQR)), procedure time, and fluoroscopy time (in minutes, median [IQR]) in patients receiving EST for BAO. Patients who received EST for BAO were matched case by case with patients who received EST for MCAO according to number of thrombectomy attempts, target vessel reperfusion result, and thrombectomy technique.ResultsOverall 180 patients (n = 90 in each group) were included in this analysis. General anesthesia was conducted more often during EST of BAO (BAO: 75 (83.3%); MCAO: 18 (31.1%), p < 0.001). Procedure time (BAO: 31 (20–43); MCAO: 27 (18–38); p value 0.226) and fluoroscopy time (BAO: 29 (20–59); MCAO: 29 (17–49), p value 0.317) were comparable. Radiation exposure was significantly higher in patients receiving EST for BAO (BAO: 123.4 (78.7–204.2); MCAO: 94.3 (65.5–163.7), p value 0.046), which represents an increase by 23.7%.ConclusionEndovascular stroke treatment of basilar artery occlusions is associated with a higher radiation exposure compared with treatment of middle cerebral artery occlusions.
Highlights
To determine the radiation exposure in endovascular stroke treatment (EST) of acute basilar artery occlusions (BAO) and compare it with radiation exposure of EST for embolic middle cerebral artery occlusions (MCAO)
The analysis focuses on radiation exposure (RE), procedure time, and fluoroscopy time in EST of the posterior circulation involving acute, basilar artery occlusions (BAO) and EST of the anterior circulation involving acute occlusions of the main branch of the middle cerebral artery (MCAO)
A few deviations from precise matching were made: (i) in two patients with BAO in who no substantial reperfusion was achieved were matched with patients in who modified thrombolysis in cerebral infarction (mTICI) 2b was reached during EST of MCAO, (ii) one patients with BAO in who complete reperfusion was achieved was matched with a patient in who mTICI 2c was achieved during EST of MCAO, and (iii) one patient requiring two attempts (1 × stentretriever-thrombectomy and 1 × aspiration thrombectomy) for treatment of BOA was matched with a patient who received two aspiration thrombectomy attempts for MCAO
Summary
To determine the radiation exposure in endovascular stroke treatment (EST) of acute basilar artery occlusions (BAO) and compare it with radiation exposure of EST for embolic middle cerebral artery occlusions (MCAO). Radiation exposure was significantly higher in patients receiving EST for BAO (BAO: 123.4 (78.7–204.2); MCAO: 94.3 (65.5–163.7), p value 0.046), which represents an increase by 23.7%. Conclusion Endovascular stroke treatment of basilar artery occlusions is associated with a higher radiation exposure compared with treatment of middle cerebral artery occlusions. Key Points There is a significant difference in radiation exposure of endovascular stroke treatment for basilar artery occlusions compared with middle cerebral artery occlusions. When reference levels for endovascular stroke treatment are discussed, separated recommendations for EST of the anterior and the posterior circulation appear reasonable. The objective of this study was to compare RE of EST in the anterior and posterior circulation
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