RESUMO
PURPOSE: Identification of independent treatment factors associated with high radiation exposure during endovascular mechanical thrombectomy (EMT) in acute ischemic stroke. METHODS: This retrospective analysis included all patients treated by means of EMT during the 2year period 2017-2018 in a comprehensive stroke center. The EMT were performed by four internal and three external certified neuroradiologists in a clinic overlapping on call system. Radiation exposure as the dependent variable (dose area product DAP, Gyâ¯â cm2) was dichotomized in <â¯100â¯Gyâ¯â cm2 and ≥â¯100â¯Gyâ¯â cm2. Independent variables were age (<â¯75 years vs. ≥â¯75 years), time of intervention (during vs. beyond workday), treating neuroradiologist (internal vs. external), occlusion type ("mono" vs. "tandem"), reperfusion success (TICI 0-2A vs. TICI 2B/3), recanalization attempts (≤â¯2 vs. >â¯2) and dose protocol (normal dose in 2017 vs. low dose in 2018). RESULTS: The EMT treatment of 208 patients (111 female, 97 male, mean age 71.6 years) was analyzed. Median DAP was 86.6â¯Gyâ¯â cm2 and could be reduced from 104.8â¯Gyâ¯â cm2 (Nâ¯= 105 in 2017) to 73.3â¯Gyâ¯â cm2 (Nâ¯= 103 in 2018) with LD program. Univariable and multivariable binary logistic regression analysis revealed a significantly increased radiation exposure (≥â¯100â¯Gyâ¯â cm2) in tandem occlusion type (Pâ¯< 0.001), >â¯2 recanalization attempts (Pâ¯< 0.001) and normal dose protocol (Pâ¯= 0.002). CONCLUSION: Low dose programs can significantly reduce the radiation exposure in EMT. High radiation exposure is significantly associated with more than two recanalization attempts and in cases of tandem occlusions.