ObjectiveTo 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.DesignThis was a retrospective analysis.SettingA community hospital during the initial phase of adopting a TRA-first approach.ParticipantsA resultant 215 subjects who only underwent diagnostic cerebral angiograms (DCA) after excluding all therapeutic procedures and patients under 18 years.InterventionsOnly DCA from 1 May 2018 to 31 January 2021.Main outcome measuresWe 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.ResultsFT 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.ConclusionsAdopting 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.
encapsulation around the material. A protein-resistant, liquidto-solid curing material could have expanded use as anon-fouling, protein-resistant coating for a variety of metal-based implants. Materials and MethodsThe resistance to protein adsorption is quantified via protein depletion from the blood, as well as through analysis of desorbed proteins from sample surfaces via Tween-20. Detection and quantification of proteins is performed via PPODA-QT samples (n=12) were prepared and cured in 4mm diameter cylindrical molds with a height of 10mm. PPODA-QT samples were each immersed in 1.5mL of heparinized rabbit whole blood within a 2mL polypropylene vial. Vials were placed on a shaker plate for15 minutes to ensure maximal interfacing between blood and the samples. With the majority of protein adsorption happening within seconds, 15 minutes is sufficient for protein adsorption. Positive controls(n=4) were created by preparing 4mm diameter and 10mm thick polyurethane cylinders and subjecting them to the same blood immersion procedure. Negative controls (n=4) were created by filling vials with blood and no sample to give a baseline level for protein adsorption onto the vials themselves. Proteins will be identified and quantified via label-free spectroscopy techniques. Results PPODA-QT has been shown to exhibit exemplary protein-resistant properties as well as minimal encapsulation and inflammatory response when implanted while providing a relatively uniform surface for neointimal tissue growth across the device at the neck of the aneurysm. Comparison of PPODA-QT to the positive controls results in statistically significant reduction of protein depletion from blood samples. Verification of this result via analysis of desorbed proteins is underway. Conclusion The protein-resistance of PPODA-QT as shown in this study makes it an interesting material candidate for a variety of surgical applications. A liquid-to-solid curing material with inherent protein-resistant properties could be utilized not only as a novel liquid embolic for treatment of intracranial aneurysms and AVMs, but could also be used as a nonfouling, bioinert coating for metallic implants such as stents, flow diverters, and coils. Disclosures W.
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