Clinical audit comparing radiation dose metrics between WEB and coil embolisation in the treatment of intracranial aneurysms

Hazel Murphy; Andrew Scally; Damon Andrew; James Lord; Gerald Wyse; Noel Fanning; Rena Young; Niamh Moore

doi:10.1016/j.jmir.2021.11.013

Clinical audit comparing radiation dose metrics between WEB and coil embolisation in the treatment of intracranial aneurysms

J Med Imaging Radiat Sci. 2022 Mar;53(1):75-80. doi: 10.1016/j.jmir.2021.11.013. Epub 2021 Dec 20.

Authors

Hazel Murphy¹, Andrew Scally², Damon Andrew³, James Lord³, Gerald Wyse³, Noel Fanning³, Rena Young⁴, Niamh Moore⁵

Affiliations

¹ Medical Imaging and Radiation Therapy, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, T12 AK54 Ireland.
² Medical Imaging and Radiation Therapy, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, T12 AK54 Ireland. Electronic address: andrew.scally@ucc.ie.
³ Department of Radiology, Cork University Hospital, Wilton Road, Cork, T12 DFK4 Ireland.
⁴ Medical Imaging and Radiation Therapy, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, T12 AK54 Ireland. Electronic address: rena.young@ucc.ie.
⁵ Medical Imaging and Radiation Therapy, School of Medicine, UG Assert, Brookfield Health Sciences, University College Cork, T12 AK54 Ireland. Electronic address: niamh.moore@ucc.ie.

PMID: 34949561
DOI: 10.1016/j.jmir.2021.11.013

Abstract

Introduction: Intrasaccular flow disruption is a new and effective endovascular treatment for intracranial aneurysms. While endovascular treatment is a minimally invasive procedure, it does carry a radiation risk. As radiation dose should be kept as low as reasonably achievable (ALARA), the main objective of this study was to analyse KAP (kerma area product), fluoroscopy and procedure time during the treatment of aneurysms treated with coiling and the Woven-EndoBridge (WEB) device. A secondary objective was to look at the reference air kerma (RAK) to determine if the patient receives a dose that could cause tissue effects.

Methods: KAP, fluoroscopy and procedure time were retrospectively analysed in patients who had an aneurysm treatment. Aneurysms with diameters of 4-11mm, over a four-year period, in the anterior and posterior circulation of the brain were analysed in this study. Patients were treated by coiling or WEB. RAK were summed together in the working projection to give an estimated entrance surface dose (ESD) in cases with the highest KAP.

Results: A total of 47 aneurysms treated with WEB and 104 aneurysms treated with coiling techniques met the inclusion criteria. The average KAP was 6884.1 ± 2774.4μGym² with coiling techniques and 5658.7 ± 1602.5μGym² with WEB (p=0.006; CI =363-2086μGym²). This demonstrates an 18% reduction with WEB. Mean fluoroscopy time for coiling was 63.5 ± 42.6minutes and 33.8 ± 28.8minutes for WEB (p=<0.001; CI=16-43minutes). Fluoroscopy time was reduced by nearly 50% with WEB. On average, there was a 27-minute reduction of procedure time when using WEB compared to coiling. The RAK determined for the working projections did not exceed the 2Gy threshold for tissue effects.

Conclusion: Treatment of aneurysms using the WEB shows a reduction in KAP, fluoroscopy, and procedure time. This study further demonstrates the benefits of intrasaccular flow disruption for treatment of intracranial aneurysms.

Keywords: Coiling; ESD; ICA; KAP; WEB.

MeSH terms

Benchmarking
Clinical Audit
Endovascular Procedures* / methods
Humans
Intracranial Aneurysm* / surgery
Intracranial Aneurysm* / therapy
Radiation Dosage
Retrospective Studies