1
|
Guenego A, Mosimann PJ, Wintermark M, Heit JJ, Zuber K, Dobrocky T, Lotterie JA, Nicholson P, Marcellus DG, Olivot JM, Gonzalez N, Blanc R, Pereira VM, Gralla J, Kaesmacher J, Fahed R, Piotin M, Cognard C. Safety and Effectiveness of Neuro-thrombectomy on Single compared to Biplane Angiography Systems. Sci Rep 2020; 10:4470. [PMID: 32161286 PMCID: PMC7066129 DOI: 10.1038/s41598-020-60851-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/14/2020] [Indexed: 12/11/2022] Open
Abstract
An increasing number of centers not necessarily equipped with biplane (BP) angiosuites are performing mechanical thrombectomy (MT) in acute ischemic stroke patients. We assessed whether MT performed on single-plane (SP) is equivalent in terms of safety, effectiveness, radiation and contrast agent exposure. Consecutive patients treated by MT in four high volume centers between January 2014 and May 2017 were included. Demographic and MT characteristics were assessed and compared between SP and BP. Of 906 patients treated by MT, 576 (64%) were handled on a BP system. After multivariate analysis, contrast load and fluoroscopy duration were significantly lower in the BP group [100vs200mL, relative effect 0.85 (CI: 0.79-0.92), p = 0.0002; 22 vs 27 min, relative effect 0.84 (CI: 0.76-0.93), p = 0.0008, respectively]. There was no difference in recanalization (modified Thrombolysis-In-Cerebral-Infarction 2b-3), good clinical outcome (modified Rankin Scale 0-2), complications rates, procedure duration or radiation exposure. A three-vessel diagnostic angiogram performed prior to MT led to a significant increase in procedure duration (15% increase, p = 0.05), radiation exposure (33% increase, p < 0.0001) and contrast load (125% increase, p < 0.0001). Mechanical neuro-thrombectomy seems equally safe and effective on a single or biplane angiography system despite increased contrast load and fluoroscopy duration on the former.
Collapse
Affiliation(s)
- Adrien Guenego
- Interventional and Diagnostic Neuroradiology Department, Toulouse University Hospital, Toulouse, France.
| | | | - Max Wintermark
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, California, USA
| | - Jeremy J Heit
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, California, USA
| | - Kevin Zuber
- Statistics department, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Tomas Dobrocky
- Interventional and diagnostic Neuroradiology, Bern, Switzerland
| | - Jean Albert Lotterie
- Stereotaxic Neurosurgery Department, Toulouse University Hospital, Toulouse, France
| | - Patrick Nicholson
- Interventional and Diagnostic Neuroradiology, Toronto Hospital, Toronto, Canada
| | - David G Marcellus
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, California, USA
| | - Jean Marc Olivot
- Vascular Neurology, Stroke Department, Toulouse University Hospital, Toulouse, France
| | - Nestor Gonzalez
- Neurosurgery and Interventional Neuroradiology Department, Cedars Sinai Hospital, Los Angeles, USA
| | - Raphaël Blanc
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | | | - Jan Gralla
- Interventional and diagnostic Neuroradiology, Bern, Switzerland
| | | | - Robert Fahed
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Christophe Cognard
- Interventional and Diagnostic Neuroradiology Department, Toulouse University Hospital, Toulouse, France
| |
Collapse
|