Comparison of radiation exposure and clinical outcomes between transradial and transfemoral diagnostic cerebral approaches: a retrospective study.
cohort study
learning curve
neurointerventional devices
patient outcome assessment
vascular access devices
Journal
BMJ surgery, interventions, & health technologies
ISSN: 2631-4940
Titre abrégé: BMJ Surg Interv Health Technol
Pays: England
ID NLM: 101764673
Informations de publication
Date de publication:
2022
2022
Historique:
received:
17
08
2021
accepted:
14
12
2021
entrez:
7
2
2022
pubmed:
8
2
2022
medline:
8
2
2022
Statut:
epublish
Résumé
To identify and compare patient and procedural variables that are associated with a high radiation dose exposure and worse clinical outcomes between transradial arterial (TRA) and transfemoral arterial (TFA) approaches. This was a retrospective analysis. A community hospital during the initial phase of adopting a TRA-first approach. A resultant 215 subjects who only underwent diagnostic cerebral angiograms (DCA) after excluding all therapeutic procedures and patients under 18 years. Only DCA from 1 May 2018 to 31 January 2021. We compared radiation exposure parameters (total fluoroscopy time (FT), total radiation dose (TD) and dose area product (DAP), number of vessels injected and Patient-Reported Global Health Physical and Mental Outcome Scores (PROGHS) at 30 days postprocedure between groups. FT was significantly greater in TRA compared with TFA (p<0.001). In addition, TRA had a significantly higher TD (p=0.002) and DAP (p=0.005) when compared with TFA. Analysis of only 6-vessel DCAs also showed that TRA had a significantly higher FT, DAP and TD in comparison to TFA. Despite observing a longer FT in TRA, results showed fewer vessels injected and a notably lower success rate in acquiring a 6-vessel DCA using the TRA. Further analysis of the effect of vessel number on FT using general linear models showed that with every increase of one vessel, the FT increases by 2.2 min for TRA (p<0.001; 95% CI 1.03 to 3.36) and by 1.3 min for TFA (p<0.001; 95% CI 0.72 to 1.83). There was no significant difference between groups in PROGHS mental and physical t-scores at 30 days postprocedure, even though our cohort showed a significantly greater percentage of TRA procedures done in the outpatient setting. Adopting a TRA first approach for DCAs may be initially associated with a higher radiation dose for the patient. Better strategies and devices are needed to mitigate this effect.
Identifiants
pubmed: 35128397
doi: 10.1136/bmjsit-2021-000110
pii: bmjsit-2021-000110
pmc: PMC8785198
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e000110Informations de copyright
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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