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. 2020 Mar;30(3):1564-1570.
doi: 10.1007/s00330-019-06482-4. Epub 2019 Nov 11.

Radiation exposure and fluoroscopy time in mechanical thrombectomy of anterior circulation ischemic stroke depending on the interventionalist's experience-a retrospective single center experience

Charlotte S Weyland  1 , Felix Hemmerich  1 , Markus A Möhlenbruch  1 , Martin Bendszus  1 , Johannes A R Pfaff  2
Affiliations

Radiation exposure and fluoroscopy time in mechanical thrombectomy of anterior circulation ischemic stroke depending on the interventionalist's experience-a retrospective single center experience

Charlotte S Weyland et al. Eur Radiol. 2020 Mar.

Abstract

Purpose: To quantify the influence of interventionalist's experience on procedure time, radiation exposure, and fluoroscopy time during mechanical thrombectomy (MT) in the anterior circulation.

Methods: Retrospective analysis of an institutional review board-approved stroke database of a comprehensive stroke center focusing on radiation exposure (as per dose area product in Gy × cm2, median [IQR]), procedure, and fluoroscopy time (in minutes, median [IQR]) in patients receiving MT in anterior circulation ischemic stroke. Procedures have been assigned according to the interventionalist's experience in MT into three sequential groups: A = 1-25 procedures, B = 26-50 procedures, and C = more than 50 procedures.

Results: Overall, 696 patients have been included in this analysis (A, n = 152; B, n = 151; C, n = 393). Procedure times (A, 86 [54-131]; B, 67 [48-103], p value 0.006), fluoroscopy times (A, 39 [25-72]; B, 32 [20-53], p value 0.001) as well as radiation exposure (A, 148.13 [89.58-243.37]; B, 111.60 [70.49-180.57], p value 0.001) were significantly shorter, respectively lower in group B than in group A. Procedure times (C, 59 [36-99]), fluoroscopy times (C, 31 [16-53]), and radiation exposure (C, 113.91 [68.48-182.88]) in group C were also significantly shorter/lower than in group A (all p values < 0.0001), but comparable with group B (p values 0.071, 0.809, and 0.934).

Conclusion: This retrospective analysis demonstrates a significant influence of interventionalist's experience on procedure time, fluoroscopy time, and radiation exposure in mechanical thrombectomy in the anterior circulation.

Key points: • There is a significant influence of interventionalist's experience on procedure time, fluoroscopy time, and radiation exposure in mechanical thrombectomy in the anterior circulation. • Interventionalists' learning curve is steepest during the first 25 cases. • These circumstances should be considered when reference levels or guide values are established and in training of physicians performing mechanical thrombectomy to promote optimization of patient doses in the future.

Keywords: Fluoroscopy; Learning curve; Radiation exposure; Stroke; Thrombectomy.

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