Radiation Dose and Fluoroscopy Time of Endovascular Treatment in Patients with Intracranial Lateral Dural Arteriovenous
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ORIGINAL ARTICLE
Radiation Dose and Fluoroscopy Time of Endovascular Treatment in Patients with Intracranial Lateral Dural Arteriovenous Fistulae Robert Forbrig1
· Robert Stahl1 · Lucas L. Geyer1 · Yigit Ozpeynirci1 · Thomas Liebig1 · Christoph G. Trumm1
Received: 30 September 2020 / Accepted: 20 November 2020 © The Author(s) 2020
Abstract Purpose Intracranial lateral dural arteriovenous fistula (LDAVF) represents a specific subtype of cerebrovascular fistulae, harboring a potentially life-threatening risk of brain hemorrhage. Fluoroscopically guided endovascular embolization is the therapeutic gold standard. We provide detailed dosimetry data to suggest novel diagnostic reference levels (DRL). Methods Retrospective single-center study of LDAVFs treated between January 2014 and December 2019. Regarding dosimetry, the dose area product (DAP) and fluoroscopy time were analyzed for the following variables: Cognard scale grade, endovascular technique, angiographic outcome, and digital subtraction angiography (DSA) protocol. Results A total of 70 patients (19 female, median age 65 years) were included. Total median values for DAP and fluoroscopy time were 325 Gy cm2 (25%/75% percentile: 245/414 Gy cm2) and 110 min (68/142min), respectively. Neither median DAP nor fluoroscopy time were significantly different when comparing low-grade with high-grade LDAVF (Cognard I + IIa versus IIb–V; p > 0.05, each). Transvenous coil embolization yielded the lowest dosimetry values, with significantly lower median values when compared to a combined transarterial/transvenous technique (DAP 290 Gy cm2 versus 388 Gy cm2, p = 0.031; fluoroscopy time 85 min versus 170 min, p = 0.016). A significant positive correlation was found between number of arterial feeders treated by liquid embolization and both DAP (rs = 0.367; p = 0.010) and fluoroscopy time (rs = 0.295; p = 0.040). Complete LDAVF occlusion was associated with transvenous coiling (p = 0.001). A low-dose DSA protocol yielded a 20% reduction of DAP (p = 0.021). Conclusion This LDAVF study suggests several local DRLs which varied substantially dependent on the endovascular technique and DSA protocol.
Keywords Coil embolization · LDAVF · Liquid embolization · Dose area product
Availability of data and material Data not included in the submission are available in anonymized form upon request from the corresponding author. Robert Forbrig
[email protected] Robert Stahl [email protected] Lucas L. Geyer [email protected] Yigit Ozpeynirci [email protected] Thomas Liebig [email protected] Christoph G. Trumm [email protected] 1
Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
Introduction Intracranial dural arteriovenous fistulae (DAVF) are pathological shunts between meningeal arteries (i.e. fistula feeders, which commonly arise from branches of the external carotid artery) and intracranial venous sinus and/or cortical veins, a
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