Cineangiography versus standard digital subtraction angiography in mechanical thrombectomy: lowering the radiation exposure without sacrificing the outcome

Stefano Molinaro; Francesco Mistretta; Riccardo Russo; Gaetano Risi; Fabrizio Venturi; Mauro Bergui

doi:10.1136/jnis-2023-021289

Cineangiography versus standard digital subtraction angiography in mechanical thrombectomy: lowering the radiation exposure without sacrificing the outcome

J Neurointerv Surg. 2024 Jan 23:jnis-2023-021289. doi: 10.1136/jnis-2023-021289. Online ahead of print.

Authors

Stefano Molinaro¹, Francesco Mistretta², Riccardo Russo³, Gaetano Risi⁴, Fabrizio Venturi⁵, Mauro Bergui⁶

Affiliations

¹ Interventional Neuroradiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy stefanomolinaro52@gmail.com.
² Department of Surgical Sciences, Università degli Studi di Torino, Torino, Italy.
³ Surgical Science, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
⁴ Radiology, Università degli Studi di Torino, Torino, Italy.
⁵ Neuroradiology, Azienda Ospedaliera S Croce e Carle Cuneo, Cuneo, Italy.
⁶ Interventional Neuroradiology, Università degli Studi di Torino, Torino, Italy.

PMID: 38262728
DOI: 10.1136/jnis-2023-021289

Abstract

Background: Endovascular thrombectomy has become a standard procedure for the treatment of acute ischemic stroke caused by large vessel occlusion. Radiation exposure to the patient and operators during mechanical thrombectomy procedures is a concern.

Methods: The use of a high frames per second unmasked protocol-cineangiography (CINE)-derived from cardiac intervention could mitigate radiation exposure without sacrificing procedural and clinical outcomes.

Results: The analysis of a prospective-maintained monocentric database of 131 patients who underwent mechanical thrombectomy (65 with the CINE protocol and 66 with the conventional digital subtraction angiography (DSA) protocol) showed a significant reduction in radiation exposure for both air kerma (AK) and dose-area product (DAP) indicators (AK 463.7 mGy vs 772 mGy, P<0.01; DAP 41.35 Gy/cm² CINE vs 83.77 Gy/cm² DSA, P<0.01), with no differences regarding both safety and efficacy outcomes (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b 78.4% CINE and 81.5% DSA, P=0.79; overall complications rate both intracranial and extracranial 23% CINE and 19.6% DSA, P=0.65). There were no significant differences in post-thrombectomy radiographic hemorrhagic conversion rate (P=0.77) or functional independence on discharge defined as modified Rankin Scale score ≤2 (P=0.39). A post-hoc image assessment of vessel point occlusion and recanalization mTICI score performed by three experienced interventional neuroradiologists not involved in the procedure showed a non-significant difference between the two groups regarding occlusion point (0.928 vs 0.953, P=0.31) and recanalization grade (0.814 vs 0.847, P=0.62).

Conclusions: Our initial experience demonstrated that reduction of the quality of CINE images caused no modifications in safety and efficacy and should fit within the context of diagnostic requests in an intracranial revascularization procedure.

Keywords: Angiography; Stroke; Technique; Thrombectomy.