Feasibility of low-dose digital subtraction angiography protocols for the endovascular treatment of intracranial dural a
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INTERVENTIONAL NEURORADIOLOGY
Feasibility of low-dose digital subtraction angiography protocols for the endovascular treatment of intracranial dural arteriovenous fistulas Yunsun Song 1 & Seongsik Han 2 & Byung Jun Kim 3 & Seong Heum Oh 2 & Jin Su Kim 2 & Tae Il Kim 2 & Deok Hee Lee 1 Received: 21 June 2020 / Accepted: 20 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Among neurointerventional procedures, the embolization of complex shunt lesions usually requires more radiation dose. We aimed to evaluate the procedural outcome and safety in using low-dose DSA protocols for intracranial dural arteriovenous fistula (AVF) embolization treatment. Methods Between January 2014 and July 2018, 55 patients with dural AVFs who underwent endovascular treatment were included in the study. The low-dose group (n = 27) included from January 2016 used various low-dose DSA protocols made by modifying the thickness of the copper filter or the detector entrance dose. We compared radiation dose metrics, such as airkerma, kerma-air product (KAP), and fluoroscopy time, as well as clinical and imaging outcomes with the conventional-dose group (n = 28) included before January 2016. Results The total KAP was 40.1% lower in the low-dose group (87.9 vs. 146.7 Gy cm2, p = 0.002). The average number of DSA runs (25.1 vs. 25.5, p = 0.86) and fluoroscopy times (77.4 vs. 69.7 min, p = 0.48) were similar between the groups. An immediate favorable occlusion rate (total or near total occlusion) was achieved in 41 (74.5%) patients. Ten patients (18.2%) underwent additional procedures due to residual (n = 6) and/or recurrent (n = 5) lesions. At a median of 10 months follow-up, 45 patients (86.5%) had achieved favorable occlusion. Treatment outcomes showed no significant between-group differences. There was one case (1.8%) of procedure-related complications in the low-dose group. All but one patient showed favorable clinical outcomes (modified Rankin score ≤ 2). Conclusion The low-dose protocols were feasible by showing significant radiation dose reduction and acceptable procedural outcome. Keywords Angiography . Intervention . Technique . Vascular malformation . Standards
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00234-020-02537-2) contains supplementary material, which is available to authorized users. * Deok Hee Lee [email protected] 1
Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
2
Department of Radiologic Technology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
3
Advanced Therapies, Siemens Healthineers Ltd, Seoul, South Korea
Neurointerventional procedures inevitably include a certain burden of radiation exposure [1–5]. Following the ALARA principle, many studies on optimized low-dose protocols for diagnostic cerebral angiography have been conducted worldwide
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