Effect of mode of anesthesia on radiation exposure in patients undergoing endovascular recanalization of anterior circulation embolic stroke

2019 ◽  
Vol 12 (5) ◽  
pp. 455-459 ◽  
Author(s):  
Felix Hemmerich ◽  
Charlotte S Weyland ◽  
Silvia Schönenberger ◽  
Peter A Ringleb ◽  
Markus A Möhlenbruch ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Retrospective Analysis ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
Dose Area Product ◽  
Endovascular Recanalization ◽  
Institutional Review ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Area Product

PurposeTo determine the effect of general anesthesia (GA) versus conscious sedation (CS) on radiation exposure (RE), procedure time (PT), and fluoroscopy time (FT) in patients receiving endovascular stroke treatment (EST) for large vessel occlusions (LVOs) in the anterior circulation.MethodsRetrospective analysis of an institutional review board−approved prospective stroke database of a comprehensive stroke center focusing on RE (as dose area product (DAP) in Gy.cm², median (IQR)), PT, and FT (in minutes, median (IQR)) in patients receiving EST for LVOs of the anterior circulation according to the mode of anesthesia during the intervention.ResultsOverall 544 patients were included in this analysis (GA: n=143, CS: n=401). For all included LVOs in the anterior circulation PTs (GA: 69 (44–100); CS: 59 (37–99); p=0.235), FTs (GA: 33 (20–56); CS: 29 (16–51); p=0.286), and RE (DAP, GA: 116.23 (73.47–173.41); CS: 110.5 (68.35–184.65); p=0.929) were comparable. In a subgroup analysis of occlusions of the middle cerebral artery (M1-segment; GA: n=80/544, 14.7%; CS: n=211/544, 38.8%), PTs (GA: 69 (37–101); CS: 54 (35 – 89); p=0.223), FTs (GA: 33 (19–55); CS: 25 (14–48); p=0.264), and RE (DAP, GA: 110.91 (66.8–169.12); CS: 103.8 (63.17–181); p=0.893) were similar.ConclusionIn this retrospective analysis, no effect of the mode of anesthesia on the radiation exposure during EST was detected as GA and CS showed comparable PT, FT, and DAPs.

scholarly journals Effect of treatment technique on radiation exposure in mechanical thrombectomy for acute ischaemic stroke: A matched-pair analysis

2020 ◽  
Vol 33 (4) ◽  
pp. 286-291 ◽  
Author(s):  
Charlotte S Weyland ◽  
Ulf Neuberger ◽  
Fatih Seker ◽  
Simon Nagel ◽  
Peter Arthur Ringleb ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Mechanical Thrombectomy ◽  
Patient Characteristics ◽  
Relative Increase ◽  
Matched Pair ◽  
Treatment Technique ◽  
Anterior Circulation ◽  
Dose Area Product ◽  
Matched Pair Analysis ◽  
Area Product

Objective This study aimed to compare radiation exposure (RE) in patients receiving mechanical thrombectomy (MT) for large-vessel occlusions in the anterior circulation using direct thrombo-aspiration (DT) versus stent-retriever thrombectomy under continuous distal aspiration (STA). Methods This was a retrospective single-centre analysis of an Institutional Review Board−approved stroke database of a comprehensive stroke centre focusing on RE per dose area product, procedure time (PT) and fluoroscopy time (FT) in patients receiving MT. Patients who received MT with DT were matched with patients treated using STA according to occlusion location, mode of anaesthesia, manoeuvre count and sex. Results Apart from patient age (DT: M = 74 years (standard deviation ( SD)=13 years); STA: M = 79 years ( SD = 11 years); p = 0.023), there was no difference in baseline patient characteristics ( n = 68 per group). PT (DT: median = 26 minutes (interquartile range (IQR) = 21–38 minutes); STA: median = 49 minutes (IQR 37–77 minutes); p < 0.0001) and FT (DT: median = 12 minutes (IQR 7–18 minutes); STA: median = 26 minutes (IQR 14–43 minutes); p < 0.0001) were shorter in patients who received MT using DT. RE (DT: median = 62.6 Gy·cm2 (IQR 41.7–89.4 Gy·cm2); STA: median = 89.8 Gy·cm2 (IQR 53.7–131.7 Gy·cm2); p = 0.034) was significantly lower in patients who received MT using DT. This represents a relative increase of RE, FT and PT by 43.6%, 116.6% and 88.5%, respectively, in patients who received MT using STA. Conclusion MT using DT is associated with shorter FT and PT and lower RE compared to matched patients treated with STA.

scholarly journals Non-Contrast CT and CT-Angiogram for Late Window Ischemic Stroke Treatment Selection

2020 ◽  
Vol 47 (3) ◽  
pp. 309-313
Author(s):  
Marie-Claude Beaulieu ◽  
Ahmad Nehme ◽  
Francis Fortin ◽  
Fatine Karkri ◽  
Nicole Daneault ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Independence ◽  
Pragmatic Approach ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
Ct Angiogram ◽  
Retrospective Comparison ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Contrast Ct

ABSTRACT:Introduction:The benefit of late window endovascular treatment (EVT) for anterior circulation ischemic stroke has been demonstrated using perfusion-based neuroimaging. We evaluated whether non-contrast CT (NCCT) and CT-angiogram (CTA) alone can select late-presenting patients for EVT.Methods:We performed a retrospective comparison of all patients undergoing EVT at a single comprehensive stroke center from January 2016 to April 2017. Patients planned for EVT were divided into early (<6 hours from onset) and late (≥6 hours from onset or last time seen normal) window groups. Incidence of symptomatic hemorrhagic transformations (sHTs) at 24 hours and 3-month modified Rankin scores (mRSs) were compared.Results:During the study period, 204 (82%) patients underwent EVT in the early and 44 (18%) in the late window. Median (interquartile range) NIH Stroke Scale Score was similar between groups (early: 18 [15–23] vs. late: 17 [13–21]), as were median ASPECT scores (early: 9 [8–10] vs. late: 9 [7–9]). In the late window, 42 (95%) strokes were of unknown onset. Similar proportions of sHT occurred at 24 hours (early: 12 [6%] vs. late: 4 [9%], p = 0.43). At 3 months, the proportion of patients achieving functional independence (mRS 0–2) were comparable in the early (80/192 [42%]) and late (16/41 [39%]) windows (p = 0.76).Conclusion:NCCT- and CTA-based patient selection led to similar functional independence outcomes and low proportions of sHT in the early and late windows. In centers without access to perfusion-based neuroimaging, this pragmatic approach could be safe, particularly for strokes of unknown onset.

scholarly journals Regular hours vs. on-call endovascular interventions for acute stroke treatment: initial single-center experience by interventional cardiologists

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Piayda ◽  
M Hornung ◽  
I Grunwald ◽  
K Sievert ◽  
S Bertog ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Hospital Stay ◽  
Acute Stroke ◽  
Stent Retriever ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
Dose Area Product ◽  
Acute Stroke Treatment ◽  
Area Product

Abstract Background Endovascular treatment for acute stroke with large vessel occlusion became the mainstay therapy but remains limited due to lack of trainees and specialized centers. To offer this therapeutical option to a vast population, interventional cardiologists joined interdisciplinary stroke teams. Because of limited experience, it remains unclear if the timing of the procedure (i.e., regular hours vs. on-call time) may influence quality, time-effectiveness and outcomes. Purpose To investigate if the timing of the procedure (i.e., regular hours vs. on-call time) significantly influences procedural parameters and outcomes of patients undergoing acute endovascular stroke treatment. Methods Consecutive patients undergoing acute endovascular stroke treatment from 07/2012 – 10/2020, treated by cardiologists, were reviewed. Baseline characteristics, procedural aspects and clinical outcomes were retrospectively collected. Cases were divided into two groups, depending on the timing of the procedure: on-call time (OC, i.e., weekend days, public holidays and documented “call in” of the on-call service) vs. regular hours (RH, i.e., all other procedures) and outcomes subsequently compared. Results One-hundred-thirteen consecutive patients underwent endovascular treatment for acute stroke; of those 77 (68.1%) during regular hours and 36 (31.9%) during on-call time. Patients were in their early 70ies and risk factors such as arterial hypertension, diabetes mellitus, dyslipidemia and atrial fibrillation were evenly distributed. Modified Ranking Scale (mRS) at presentation was 5 in both groups and decreased to 3 at discharge. The anterior circulation was most often affected (RH: 90.9% vs. OC: 94.4%, p=0.518) and a stent retriever only strategy commonly chosen (RH: 42.8% vs. OC: 30.5%, p=0.211), followed by a combined approach of stent retriever use and aspiration (RH: 25.9% vs. OC: 27.7%, p=0.752). Door-to-needle time (RH: 0:55h IQR [0:45–1:22] vs. OC: 1:05h IQR [0:54–1:30], p=0.237) and procedure duration (RH: 0:48h IQR [0:30–1:25] vs. OC: 0:58h IQR [0:35–1:46], p=0.214) were comparable. Contrast agent use and radiation time (RH: 17.6 min IQR [11.7–29.3] vs. OC: 17.6 min IQR [12.1–33.6]) did not differ between groups, however patients in the OC group experienced a higher dose area product (RH: 4827mGy cm2 IQR [1567–14092] vs. 12727mGy cm2 [6732–18889], p&lt;0.001). The combined quality endpoint, comprising of TICI IIb/III flow after the procedure, no embolization to new territory and no symptomatic intracranial bleeding during in hospital stay was met in 85.5% of patients in the RH group and 80.5% of the on-call group (p=0.485). Death during in-hospital stay was observed in 22% of patients in the RH group and 11.1% of the OC group (p=0.163). Conclusions Endovascular intervention for acute stroke treatment during on-call time is as effective and safe as if performed during regular hours but associated with a higher dose area product. FUNDunding Acknowledgement Type of funding sources: None.

Abstract WMP20: Effect of Leukoaraiosis on Outcomes of Mechanical Thrombectomy and Proposed New Leukoaraiosis-Aspects Score

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Waleed Brinjikji ◽  
John Benson ◽  
Alejandro A Rabinstein ◽  
David F Kallmes
Keyword(s):  
Mechanical Thrombectomy ◽  
Primary Outcome Measure ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Endovascular Recanalization ◽  
Poor Outcomes ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Fazekas Scale

Background and Purpose: Leukoaraiosis is a poor prognostic marker for patients with acute ischemic stroke (AIS). This study sought to assess if severity of leukoaraiosis is associated with outcome in patients with AIS following endovascular thrombectomy, and to propose a leukoaraiosis-related modification to the ASPECTS score to improve its predictive value for good outcome. Methods: We analyzed consecutive patients with AIS that underwent mechanical thrombectomy for anterior circulation large vessel occlusion at our comprehensive stroke center. Leukoaraiosis burden was graded using the Fazekas scale (combined scores from two locations categorically divided into no leukoaraiosis (score = 0), mild (1-2), moderate (3-4) and severe (5-6)). The primary outcome measure was 90-day mRS. A proposed Leukoaraiosis-ASPECTS (“L-ASPECTS”) was calculated by subtracting values from the traditional ASPECT based on leukoaraiosis severity (1 point subtracted if mild, 2 if moderate, 3 if severe). Results: Of 174 included patients, 89 (51.2%) were female; average age was 68.0±9.1. 28 (16.1%) had no leukoaraiosis, 66 (37.9%) had mild, 62 (35.6%) had moderate, and 18 (10.3%) had severe. Leukoaraiosis severity was associated with worse 90-day mRS among all patients (p=0.0005) as well as those that were successfully revascularized (p=0.0002). A multivariate analysis confirmed that leukoaraiosis burden was associated with worse 90-day mRS among all patients (mild: p=0.006; moderate: p=0.002; severe: p=0.03), as well as those that underwent successful thrombectomies (p=0.005). Both L-ASPECTS and ASPECTS were associated with poor outcomes, but the association was stronger with L-ASPECTS (p<0.0001 and AUC=0.7 for L-ASPECTS; p=0.04 and AUC=0.59 for ASPECTS). Conclusion: Leukoaraiosis severity on pre-mechanical thrombectomy NCCT is associated with worse 90-day outcome in patients with AIS following endovascular recanalization, and is an independent risk factor for worse outcomes. A proposed L-ASPECTS score had stronger association with outcome than the traditional ASPECTS score.

Noninvasive patient tracker mask for spinal 3D navigation: does the required large-volume 3D scan involve a considerably increased radiation exposure?

2020 ◽  
Vol 33 (6) ◽  
pp. 838-844
Author(s):  
Jan-Helge Klingler ◽  
Ulrich Hubbe ◽  
Christoph Scholz ◽  
Florian Volz ◽  
Marc Hohenhaus ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Image Data ◽  
3D Image ◽  
Flat Panel ◽  
3D Navigation ◽  
Data Set ◽  
Dose Area Product ◽  
Flat Panel Detector ◽  
3D Scan ◽  
Area Product

OBJECTIVEIntraoperative 3D imaging and navigation is increasingly used for minimally invasive spine surgery. A novel, noninvasive patient tracker that is adhered as a mask on the skin for 3D navigation necessitates a larger intraoperative 3D image set for appropriate referencing. This enlarged 3D image data set can be acquired by a state-of-the-art 3D C-arm device that is equipped with a large flat-panel detector. However, the presumably associated higher radiation exposure to the patient has essentially not yet been investigated and is therefore the objective of this study.METHODSPatients were retrospectively included if a thoracolumbar 3D scan was performed intraoperatively between 2016 and 2019 using a 3D C-arm with a large 30 × 30–cm flat-panel detector (3D scan volume 4096 cm3) or a 3D C-arm with a smaller 20 × 20–cm flat-panel detector (3D scan volume 2097 cm3), and the dose area product was available for the 3D scan. Additionally, the fluoroscopy time and the number of fluoroscopic images per 3D scan, as well as the BMI of the patients, were recorded.RESULTSThe authors compared 62 intraoperative thoracolumbar 3D scans using the 3D C-arm with a large flat-panel detector and 12 3D scans using the 3D C-arm with a small flat-panel detector. Overall, the 3D C-arm with a large flat-panel detector required more fluoroscopic images per scan (mean 389.0 ± 8.4 vs 117.0 ± 4.6, p < 0.0001), leading to a significantly higher dose area product (mean 1028.6 ± 767.9 vs 457.1 ± 118.9 cGy × cm2, p = 0.0044).CONCLUSIONSThe novel, noninvasive patient tracker mask facilitates intraoperative 3D navigation while eliminating the need for an additional skin incision with detachment of the autochthonous muscles. However, the use of this patient tracker mask requires a larger intraoperative 3D image data set for accurate registration, resulting in a 2.25 times higher radiation exposure to the patient. The use of the patient tracker mask should thus be based on an individual decision, especially taking into considering the radiation exposure and extent of instrumentation.

Estimation of Radiation Exposure in the Pediatric Cath Lab in Ain Shams University; Cross-Sectional Observational Study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Abdelrazik ◽  
Youssef Amin ◽  
Alaa Roushdy ◽  
Maiy El Sayed
Keyword(s):  
Radiation Exposure ◽  
Radiation Dosage ◽  
University Hospital ◽  
Heart Catheterization ◽  
Radiation Doses ◽  
Device Closure ◽  
Cross Sectional ◽  
Dose Area Product ◽  
Area Product ◽  
Hospital Pediatric

Abstract Aim and objectives The aim of the study is to assess the average radiation doses recorded per procedure in Ain Shams University Hospital pediatric cath lab to set benchmarks of radiation exposure in our institute. Patients and Methods The study included 198 patients who presented to Ain Shams cardiac pediatric cath lab who undergone interventional (BPV, BAV, ASD device closure, VSD device closure, PDA coil/device closure, Coarctation Stent/balloon) and diagnostic (Hemodynamics study, Diagnostic cath) heart catheterization. Radiation doses were measured without any interference with the operator’s preferences. Results Radiation dosages were measured in total AirKerma, Dose area product (DAP), and fluoroscopy time to set the benchmarks for radiation exposure in our institute per procedure. VSD device closure showed the highest radiation exposure followed by Coarctation stenting. Lowest radiation dosage was in PDA coil closure followed by ASD device closure then BPV. Conclusion Benchmarks for radiation exposure per procedure in pediatric cath lab in our institute were set and compared to each other.

scholarly journals Radiation exposure of adrenal vein sampling: a German Multicenter Study

2018 ◽  
Vol 179 (4) ◽  
pp. 261-267 ◽  
Author(s):  
C T Fuss ◽  
M Treitl ◽  
N Rayes ◽  
P Podrabsky ◽  
W K Fenske ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Adrenal Vein ◽  
University Hospitals ◽  
Adrenal Vein Sampling ◽  
Dose Area Product ◽  
Systematic Assessment ◽  
Sampling Locations ◽  
Subtype Differentiation ◽  
Area Product ◽  
Design And Methods

Objective Adrenal vein sampling (AVS) represents the current diagnostic standard for subtype differentiation in primary aldosteronism (PA). However, AVS has its drawbacks. It is invasive, expensive, requires an experienced interventional radiologist and comes with radiation exposure. However, exact radiation exposure of patients undergoing AVS has never been examined. Design and methods We retrospectively analyzed radiation exposure of 656 AVS performed between 1999 and 2017 at four university hospitals. The primary outcomes were dose area product (DAP) and fluoroscopy time (FT). Consecutively the effective dose (ED) was approximately calculated. Results Median DAP was found to be 32.5 Gy*cm2 (0.3–3181) and FT 18 min (0.3–184). The calculated ED was 6.4 mSv (0.1–636). Remarkably, values between participating centers highly varied: Median DAP ranged from 16 to 147 Gy*cm2, FT from 16 to 27 min, and ED from 3.2 to 29 mSv. As main reason for this variation, differences regarding AVS protocols between centers could be identified, such as number of sampling locations, frames per second and the use of digital subtraction angiographies. Conclusion This first systematic assessment of radiation exposure in AVS not only shows fairly high values for patients, but also states notable differences among the centers. Thus, we not only recommend taking into account the risk of radiation exposure, when referring patients to undergo AVS, but also to establish improved standard operating procedures to prevent unnecessary radiation exposure.

Abstract WP65: Clinical and Radiographic Characterization of Cerebral Hyperdensities on Post-thrombectomy Conventional Non-contrast Ct Brain: Differentiating Between Contrast Staining and Post-thrombectomy Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Hyung K Kang ◽  
Raffi Ourfalian ◽  
Emilie T Nguyen ◽  
Fernando A Torres ◽  
Lei T Feng ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Anterior Circulation ◽  
Chi Square ◽  
Imaging Characteristics ◽  
Increase Risk ◽  
Patient’S Outcome ◽  
Ct Brain ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Contrast Ct

Background: Post-interventional cerebral hyperdensities (PCHD) are present 31.2 to 87.5% of the time on post-thrombectomy (PT) CT. It can be difficult for radiologists to differentiate if PCHD represents intracerebral hemorrhage (ICH) or contrast staining using conventional CT. The ability to accurately determine the etiology of PCHD may be important for a patient’s outcome. Methods: We retrospectively investigated clinical risk factors, imaging findings, and interventional technique of patients who had a thrombectomy from 2011-2017 (n=238) at a Comprehensive Stroke Center. 112 patients with anterior circulation infarcts and immediate PT CTs as well as either a PT MRI or follow-up CT within 48 hours were included. Two experienced neuroradiologists interpreted all imaging. Baseline demographics and imaging characteristics were collected. The presence of ICH was determined by dephasing on gradient echo or by its persistence > 2 days on repeat CT. Chi-square and Fisher’s exact tests were used for statistical significance, and logistic regression to determine risk estimates. Results: 84% of patients had PCHD, of which 56% had ICH. Patients had similar demographics (ICH: median age 69, 47.5% female; non-ICH: median age 71, 42.5% female). Higher pre-thrombectomy ASPECTS score (OR 0.62, p < 0.05) decreased the risk of ICH, and higher Hounsfield units (HU) of PCHD both on immediate (OR 1.04, p < 0.05) and intermediate (OR 1.1, p < 0.0005) PT CT increased the risk of ICH. PCHDs in the deep grey matter (OR 2.84, p < 0.05) and demonstrating a confluent pattern (OR 3.9 p < 0.05) increased the likelihood of ICH. 10% increase risk of ICH was seen for every HU increase in density on PT CT at 24 or 48 hours. A 50% decrease in ICH was observed for each unit increase of the pre-thrombectomy ASPECTS score. ROC revealed the optimal cut-off for predicted probability as 0.64, sensitivity 70.2% and specificity 69.2%. The AUC for the predicted model was 0.84 (95%CI= (0.75- 0.92, p <0.0001). Conclusion: Several imaging characteristics of PCHDs and ASPECTS score can help differentiate between the PT ICH and contrast staining. Application of these variables to patients in the immediate PT period may change clinical management.

Abstract TP289: Code Neuro-Intervention a New Necessity: Reality of Shifting Stroke Care Paradigm

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Laura Suhan ◽  
Spozhmy Panezai ◽  
Jaskiran Brar ◽  
Audrey Z Arango ◽  
Anna Pullicino ◽  
...  
Keyword(s):  
Stroke Care ◽  
Work Hours ◽  
Stroke Treatment ◽  
Angiography Suite ◽  
Stroke Team ◽  
Cross Training ◽  
Code Process ◽  
Time Parameters ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Various strategies have been implemented to reduce acute stroke treatment times. A unique code process pathway was designed at our hospital specifically to be activated by the stroke team for the purpose of rapidly assembling the Neurointerventional team. Methods: Code Neurointervention (NI), was designed and tested from January 2014 to April 2014 for all the patients who presented with ischemic strokes to our community based, university affiliated comprehensive stroke center. We retrospectively analyzed all patients who had Code NI called from May 1, 2014 to April 30, 2015 and compared them to patients who underwent acute endovascular treatment the prior year (Non Code NI). The following parameters were compared: decision to recanalization and door to recanalization times. Further analysis was done to compare patients presenting during business hours (Monday-Friday 8am-5pm) and off hours using GraphPad QuickCalcs Web site. Results: There were 28 Code NI; 14 were called during work hours and 14 during off hours. The previous year 25 patients underwent acute endovascular intervention; 12 during work hours and 13 during off hours. Mean decision to recanalization time was 106 (Code NI) vs 115 minutes (Non Code NI) (p<0.0.6) during work hours and 154 (Code NI) vs 139 minutes (Non Code NI) (p<0.37) during off hours. Mean door to recanalization time was 169 (Code NI) vs 173 minutes (Non Code NI) (p<0.85) during work hours and 252 (Code NI) vs 243minutes (Non Code NI) (p< 0.75) during off hours. Subset analysis of time parameters for patients in Code NI group showed mean decision to recanalization times of 106 minutes during work hours vs 154 minutes off work hours (p<0.004). Mean door to recanalization times were 169 minutes vs 251 minutes (p<0.0003), respectively. Conclusion: Institution of Code NI significantly improved intervention time parameters during work hours as compared to off hours. Rapid assembly of the neurointervention team, rapid availability of imaging and angiography suite likely contribute to these differences. Further initiatives, such as improving neurointervention staff availability during off hours or cross training other staff can further improve acute intervention time parameters.

Sign in / Sign up

Export Citation Format

Share Document