Radiation exposure in the intra-arterial nimodipine therapy of subarachnoid hemorrhage related cerebral vasospasm

Abstract

The selective intra-arterial nimodipine application for the treatment of cerebral vasospasm (CVS) in patients after spontaneous subarachnoid hemorrhage (sSAH) is widely employed. The purpose of this study is to examine the radiation exposure and to determine local diagnostic reference levels (DRLs) of intra-arterial nimodipine therapy. In a retrospective study design, DRLs and achievable dose (AD) were assessed for all patients undergoing (I) selective intra-arterial nimodipine application or (II) additional mechanical angioplasty for CVS treatment. Interventional procedures were differentiated according to the type of procedure and the number of probed vessels. Altogether 494 neurointerventional procedures of 121 patients with CVS due to sSAH could be included. The radiation exposure indices were distributed as follows: (I) DRL 74.3 Gy·cm2, AD 59.8 Gy·cm2; (II) DRL 128.3 Gy·cm2, AD 94.5 Gy·cm2. Kruskal–Wallis test confirmed significant dose difference considering the number of probed vessels (p< 0.001). The mean cumulative dose per patient was 254.9 Gy·cm2 (interquartile range 88.6–315.6 Gy·cm2). The DRLs of intra-arterial nimodipine therapy are substantially lower compared with DRLs proposed for other therapeutic interventions, such as thrombectomy or aneurysm coiling. However, repeated therapy sessions are often required, bearing the potential risk of a cumulatively higher radiation exposure.

Evaluation of DeGIR registry data on endovascular treatment of cerebral vasospasm in Germany 2018–2021: an overview of the current care situation

“…The radiation exposure associated with the individual EVT (median DAP 4069 cGycm 2 ) appears to be moderate overall. This is consistent with recently published results from a working group from Essen that described EVT (with nimodipine) compared to other therapeutic interventions such as thrombectomy or aneurysm coiling as having a substantially lower radiation exposure [21].…”

“…Die mit der einzelnen EST verbundene Strahlenbelastung (DFP im Median 4069 cGycm²) erscheint insgesamt moderat. Dies passt zu jüngst veröffentlichten Ergebnissen einer Essener Arbeitsgruppe, welche EST (mit Nimodipin) im Vergleich mit anderen therapeutischen Interventionen wie Thrombektomie oder Aneurysmacoiling als mit substanziell geringerer Strahlenbelastung beschrieben hat [21]. Insgesamt zeigten die Auswertungen der Registerdaten sehr wenige Komplikationen im Rahmen der EST (1,2 %, überwiegend akute Thromboembolien und Dissektionen).…”