Safety and Effectiveness of Neuro-thrombectomy on Single compared to Biplane Angiography Systems

Abstract

An increasing number of centers not necessarily equipped with biplane (BP) angiosuites are performing mechanical thrombectomy (MT) in acute ischemic stroke patients. We assessed whether MT performed on single-plane (SP) is equivalent in terms of safety, effectiveness, radiation and contrast agent exposure. Consecutive patients treated by MT in four high volume centers between January 2014 and May 2017 were included. Demographic and MT characteristics were assessed and compared between SP and BP. Of 906 patients treated by MT, 576 (64%) were handled on a BP system. After multivariate analysis, contrast load and fluoroscopy duration were significantly lower in the BP group [100vs200mL, relative effect 0.85 (CI: 0.79-0.92), p = 0.0002; 22 vs 27 min, relative effect 0.84 (CI: 0.76-0.93), p = 0.0008, respectively]. There was no difference in recanalization (modified Thrombolysis-In-Cerebral-Infarction 2b-3), good clinical outcome (modified Rankin Scale 0-2), complications rates, procedure duration or radiation exposure. A three-vessel diagnostic angiogram performed prior to MT led to a significant increase in procedure duration (15% increase, p = 0.05), radiation exposure (33% increase, p < 0.0001) and contrast load (125% increase, p < 0.0001). Mechanical neuro-thrombectomy seems equally safe and effective on a single or biplane angiography system despite increased contrast load and fluoroscopy duration on the former. Multiple randomized controlled trials have demonstrated the benefits of cerebrovascular mechanical thrombectomy (MT) in acute ischemic stroke patients with emergent large vessel occlusion (AIS-ELVO) 1-6. Two further randomized trials evaluating late-onset strokes with favorable perfusion imaging 7,8 , have broadened its indications 9,10. Adequate training is necessary for these procedures, which are often more complicated than may be anticipated 11,12. Most neuro-interventionalists prefer working on biplane (BP) angiosuites since two simultaneous projections of the material and anatomical structures per contrast injection tends to reduce the risk of arterial perforation compared to single plane (SP) procedures 12,13. Nonetheless, X-ray and contrast agent exposure remain a major public health concern in terms of carcinogenesis 14-17 , risk of renal failure 18-20 or toxic reactions, respectively 21,22. Since an increasing number of centers are performing MT 12 in the context of ELVO without necessarily being equipped with BP angiosuites, there is a need to understand whether MT performed on SP is equivalent in terms of safety, effectiveness, radiation and contrast agent exposure 22 .

Analysis of 565 thrombectomies for anterior circulation stroke: A Brazilian registry

“…18,19 Whether the favorable results can be replicated in scenarios with scarce resources remain unknown. In the present study some limitations that could reduce the benefits of thrombectomy were the absence of an intensive rehabilitation program after discharge, 19,20 the use of a monoplane angio-suite, 21 the use of a single thrombectomy device, 22 and the use of standard guiding catheters in the majority of the cases. 9…”

“…18,19 Whether the favorable results can be replicated in scenarios with scarce resources remain unknown. In the present study some limitations that could reduce the benefits of thrombectomy were the absence of an intensive rehabilitation program after discharge, 19,20 the use of a monoplane angio-suite, 21 the use of a single thrombectomy device, 22 and the use of standard guiding catheters in the majority of the cases. 9 Biplane angio-suites have been widely recommended for neuro-endovascular procedures because, compared to the monoplane angio-suites, it allows for a better visualization of the vessels that would reduce the risks of vessel perforations.…”

An Electromagnetically Controllable Microrobotic Interventional System for Targeted, Real‐Time Cardiovascular Intervention

“…[56][57][58] It has also been reported that biplane fluoroscopy uses less contrast dye than single-plane fluoroscopy at the expense of higher radiation dose, as two X-ray images can be acquired by the biplane system with a single injection of contrast dye. [59,60] Given that the excessive use of contrast dye is the main cause of acute kidney injury, [61,62] biplane fluoroscopy may be more appealing to patients with renal impairment, whereas single-plane imaging may be preferred by those without. In this context, future additional studies comparing the effects of biplane versus single-plane imaging by our BXI system on the overall radiation dose, contrast load, and procedural time with our microrobotic guidewire, EMA, and MSA systems simultaneously involved are worth of investigation.…”

The Feasibility of Mechanical Thrombectomy on Single-Plane Angiosuite: An In-Depth Analysis of Procedure Time

“…To the best of our knowledge, there have been a few reports describing the feasibility of neurointervention on the SP angiosuite [ 10 , 11 ]. Previous studies have reported that the performance of MT on the SP angiosuite is feasible, and there is no difference in the total procedure time between SP and BP angiosuites [ 10 , 11 ]. This study is the first to report an in-depth analysis of MT procedure time on the SP angiosuite.…”