CardioVascular and Interventional Radiology

, Volume 36, Issue 2, pp 320–329

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

  • Loredana D’Ercole
  • Pietro Quaretti
  • Nicola Cionfoli
  • Catherine Klersy
  • Milena Bocchiola
  • Giuseppe Rodolico
  • Andrea Azzaretti
  • Francesco Lisciandro
  • Tommaso Cascella
  • Federico Zappoli Thyrion
Clinical Investigation

DOI: 10.1007/s00270-012-0392-2

Cite this article as:
D’Ercole, L., Quaretti, P., Cionfoli, N. et al. Cardiovasc Intervent Radiol (2013) 36: 320. doi:10.1007/s00270-012-0392-2

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 (NFR) 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 NFR 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 NFR 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.

Keywords

Radiation protection Dosimetry Endovascular treatment Carotid artery disease Neurointerventions Stenting/stent graft/drug eluting stents 

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2012

Authors and Affiliations

  • Loredana D’Ercole
    • 1
  • Pietro Quaretti
    • 2
  • Nicola Cionfoli
    • 2
  • Catherine Klersy
    • 3
  • Milena Bocchiola
    • 1
  • Giuseppe Rodolico
    • 2
  • Andrea Azzaretti
    • 2
  • Francesco Lisciandro
    • 1
  • Tommaso Cascella
    • 2
  • Federico Zappoli Thyrion
    • 2
  1. 1.Department of Medical PhysicsFondazione IRCCS Policlinico San MatteoPaviaItaly
  2. 2.Department of RadiologyFondazione IRCCS Policlinico San MatteoPaviaItaly
  3. 3.Biometry and Clinical Epidemiology Service, Research Department,Fondazione IRCCS Policlinico San MatteoPaviaItaly

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