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CardioVascular and Interventional Radiology

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01-04-2013 | Clinical Investigation

Patient Dose During Carotid Artery Stenting With Embolic-Protection Devices: Evaluation With Radiochromic Films and Related Diagnostic Reference Levels According to Factors Influencing the Procedure

Authors: Loredana D’Ercole, Pietro Quaretti, Nicola Cionfoli, Catherine Klersy, Milena Bocchiola, Giuseppe Rodolico, Andrea Azzaretti, Francesco Lisciandro, Tommaso Cascella, Federico Zappoli Thyrion

Published in: CardioVascular and Interventional Radiology | Issue 2/2013

Abstract

Purpose

To measure the maximum entrance skin dose (MESD) on patients undergoing carotid artery stenting (CAS) using embolic-protection devices, to analyze the dependence of dose and exposure parameters on anatomical, clinical, and technical factors affecting the procedure complexity, to obtain some local diagnostic reference levels (DRLs), and to evaluate whether overcoming DRLs is related to procedure complexity.

Materials and Methods

MESD were evaluated with radiochromic films in 31 patients (mean age 72 ± 7 years). Five of 33 (15 %) procedures used proximal EPD, and 28 of 33 (85 %) procedures used distal EPD. Local DRLs were derived from the recorded exposure parameters in 93 patients (65 men and 28 women, mean age 73 ± 9 years) undergoing 96 CAS with proximal (33 %) or distal (67 %) EPD. Four bilateral lesions were included.

Results

MESD values (mean 0.96 ± 0.42 Gy) were <2 Gy without relevant dependence on procedure complexity. Local DRL values for kerma area product (KAP), fluoroscopy time (FT), and number of frames (N_FR) were 269 Gy cm², 28 minutes, and 251, respectively. Only simultaneous bilateral treatment was associated with KAP (odds ratio [OR] 10.14, 95 % confidence interval [CI] 1–102.7, p < 0.05) and N_FR overexposures (OR 10.8, 95 % CI 1.1–109.5, p < 0.05). Type I aortic arch decreased the risk of FT overexposure (OR 0.4, 95 % CI 0.1–0.9, p = 0.042), and stenosis ≥ 90 % increased the risk of N_FR overexposure (OR 2.8, 95 % CI 1.1–7.4, p = 0.040). At multivariable analysis, stenosis ≥ 90 % (OR 2.8, 95 % CI 1.1–7.4, p = 0.040) and bilateral treatment (OR 10.8, 95 % CI 1.1–109.5, p = 0.027) were associated with overexposure for two or more parameters.

Conclusion

Skin doses are not problematic in CAS with EPD because these procedures rarely lead to doses >2 Gy.

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Title: Patient Dose During Carotid Artery Stenting With Embolic-Protection Devices: Evaluation With Radiochromic Films and Related Diagnostic Reference Levels According to Factors Influencing the Procedure
Authors: Loredana D’Ercole
Pietro Quaretti
Nicola Cionfoli
Catherine Klersy
Milena Bocchiola
Giuseppe Rodolico
Andrea Azzaretti
Francesco Lisciandro
Tommaso Cascella
Federico Zappoli Thyrion
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 2/2013
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-012-0392-2

At a glance: The STEP trials

Springer Medicine

Patient Dose During Carotid Artery Stenting With Embolic-Protection Devices: Evaluation With Radiochromic Films and Related Diagnostic Reference Levels According to Factors Influencing the Procedure

Abstract

Purpose

Materials and Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusion

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