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Feasibility of low-dose digital subtraction angiography protocols for the endovascular treatment of intracranial dural arteriovenous fistulas

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Background

Among neurointerventional procedures, the embolization of complex shunt lesions usually requires more radiation dose. We aimed to evaluate the procedural outcome and safety in using low-dose DSA protocols for intracranial dural arteriovenous fistula (AVF) embolization treatment.

Methods

Between January 2014 and July 2018, 55 patients with dural AVFs who underwent endovascular treatment were included in the study. The low-dose group (n = 27) included from January 2016 used various low-dose DSA protocols made by modifying the thickness of the copper filter or the detector entrance dose. We compared radiation dose metrics, such as air-kerma, kerma-air product (KAP), and fluoroscopy time, as well as clinical and imaging outcomes with the conventional-dose group (n = 28) included before January 2016.

Results

The total KAP was 40.1% lower in the low-dose group (87.9 vs. 146.7 Gy cm2, p = 0.002). The average number of DSA runs (25.1 vs. 25.5, p = 0.86) and fluoroscopy times (77.4 vs. 69.7 min, p = 0.48) were similar between the groups. An immediate favorable occlusion rate (total or near total occlusion) was achieved in 41 (74.5%) patients. Ten patients (18.2%) underwent additional procedures due to residual (n = 6) and/or recurrent (n = 5) lesions. At a median of 10 months follow-up, 45 patients (86.5%) had achieved favorable occlusion. Treatment outcomes showed no significant between-group differences. There was one case (1.8%) of procedure-related complications in the low-dose group. All but one patient showed favorable clinical outcomes (modified Rankin score ≤ 2).

Conclusion

The low-dose protocols were feasible by showing significant radiation dose reduction and acceptable procedural outcome.

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Authors and Affiliations

  1. Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Yunsun Song & Deok Hee Lee

  2. Department of Radiologic Technology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

    Seongsik Han, Seong Heum Oh, Jin Su Kim & Tae Il Kim

  3. Advanced Therapies, Siemens Healthineers Ltd, Seoul, South Korea

    Byung Jun Kim

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  1. Yunsun Song
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Correspondence to Deok Hee Lee.

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The institutional review board at Asan Medical Center approved this study (2020–0198).

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The IRB at Asan Medical Center waived the requirement to obtain written informed consent from the patients as this study is a retrospective study, and it is expected that the risk to study subjects will be extremely low.

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Song, Y., Han, S., Kim, B.J. et al. Feasibility of low-dose digital subtraction angiography protocols for the endovascular treatment of intracranial dural arteriovenous fistulas. Neuroradiology 63, 267–273 (2021). https://doi.org/10.1007/s00234-020-02537-2

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