Abstract:

Aim: was to study the impact of angiographic projection on patient and operator radiation dose during endovascular interventions aimed at diagnosing and treating cerebrovascular diseases.

Materials and methods: in experiment, radiation dose rate of phantom model (cGy?cm²/s) and equivalent dose rate from scattered radiation (mSv/h) measured in the area of conditional location of operator were studied when the angle of the X-ray tube was changed in modes of digital subtraction angiography (DSA) and fluoroscopy. Radiation dose rate of endovascular surgeon (mSv/h) was assessed during 12 cerebral angiography procedures and 15 neuro-interventions in general angiographic projections. Values of the kerma-area product (Gy?cm²), fluoroscopy time (min), operator exposure dose (µSv) during 87 procedures of endovascular occlusion of aneurysm of cavernous and supraclinoid sections of internal carotid arteries (ICA) were retrospectively analyzed to indirectly assess the effect of angiographic projection on patient and surgeon occupational dose. Interventions were divided into 2 groups depending on the location of detected aneurysm. The 1st group included 35 operations in the right ICA, the 2nd group included 53 operations in the left ICA.

Results: in experimental study, highest values of radiation dose rate of the phantom model were found in frontal projection with cranial angulation, lowest - in lateral and oblique projections; The highest average dose rates from scattered radiation in operator's area were found in left lateral projections whereas the smallest in right lateral projection in DSA mode and also in frontal and right lateral projections in fluoroscopy mode.

When studying doses of scattered radiation during neuro-interventional procedures, it was found that when the position of the X-ray tube changes from 0° in the direction of left lateral projection, an increase in the average dose rate of the operator in the DSA mode is up to 2,6 times, with fluoroscopy - up to 2,4 times. The equivalent dose rate in left lateral projection is up to 1.5 times higher than in right lateral projection. In left oblique projection, there is an increase in dose rate up to 2,3 times compared to right oblique projection.When comparing radiation exposure indicators during aneurysm embolization procedures, a significant increase in operator exposure doses is observed in group of interventions in the left ICA.

Conclusion: when performing neuro-interventional procedures, it is possible to achieve a significant reduction in radiation exposure to patient and operator without a significant loss in image quality along with maintaining optimal visualization of pathological changes by choosing angiographic projections with lower radiation doses.

Abstract: 

Aim: was to present the experience of using blockers of IIb/IIIa glycoprotein receptors in treatment of thromboembolic complications of endovascular treatment of cerebral aneurysms.

Materials and methods: from December 2007 to June 2021, 695 patients underwent embolization of cerebral aneurysms. Thromboembolic complications were observed in 45 patients (6,5%), blockers of IIb/IIIa glycoprotein receptors were used in 32 patients (4,6%).

Results: blockers of IIb/IIIa glycoprotein receptors were used in 10,1% of patients with embolization of aneurysms and stent implantation, in 9,2% of cases with implantation of flow-diverters, and in 1% of patients with embolization of aneurysms using only coils. Effective restoration of blood flow was observed in 90,6% of patients. Intracranial hemorrhagic complications were not observed. The incidence of bleeding from the gastrointestinal tract was 6,3%, the incidence of puncture hematomas was 12,5%.

Conclusion: blockers of glycoprotein IIb/IIIa receptors can be effectively and safely used in treatment of thromboembolic complications of endovascular treatment of cerebral aneurysms.

References

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2.     Kiselev VS, Gafurov RR, Sosnov AO, Perfil’ev AM. Using of low-profile stents in the endovascular treatment of complex aneurysms of the brain. Neyrokhirurgiya. 2018; 20(1): 49-55 [In Russ].

https://doi.org/10.17650/1683-3295-2018-20-1-49-55

3.     Dornbos D, Katz JS, Youssef P, et al. Glycoprotein IIb/IIIa Inhibitors in Prevention andиRescue Treatment of Thromboembolic Complications During Endovascular Embolization of Intracranial Aneurysms. Neurosurgery. 2017; 0: 1-10.

https://doi.org/10.1093/neuros/nyx170J

4.     Kansagra AP, McEachern JD, Madaelil ThP, et al. Intra-arterial versus intravenous abciximab therapy for thromboembolic complications of neuroendovascular procedures: case review and meta-analysis. NeuroIntervent Surg. 2017; 9: 131-136.

https://doi.org/10.1136/neurintsurg-2016-012587

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https://doi.org/10.3174/ajnr.A4066

6.     Lin L-M, Jiang B, Campos JK, et al. Coon Strategy for the Management of Acute Intraprocedural Thromboembolic Complications during Pipeline Flow Diversion Treatment of Intracranial Aneurysms. Intervent Neurol. 2018; 7: 218-232.

https://doi.org/10.1159/000486458

7.     Cheung NK, Carr MW, Ray U, et al. Platelet Function Testing in Neurovascular Procedures: Tool or Gimmick? Intervent Neurol 2019; 8: 123-134.

https://doi.org/0.1159/000496702

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Abstract:

Aim: was to evaluate immediate and long-term results of using the catheter-directed thrombosis (CDT) in patients with acute iliofemoral thrombosis.

Materials and methods: the study included 26 patients (9 men and 17 women aged 31-70) with primary or iliofemoral thrombosis, which was made by CDT Assessment of immediate results was conducted and long-term results were tracked after 12 months.

Results: technical success of treatment was achieved in 22 (84,6%) patients. In 7 (26.9%) patients after the completion of CDT, hemodynamically significant stenoses were identified and addition stenting of iliac veins were performed. Preservation of primary permeability after 12 months was observed in 26 patients (96.2%). The presence of pathological venous reflux was observed in 6(23.1%) cases. Development of post-thrombotic disease (PTD) of mild and medium severity was observed in 7 (26.9%) patients.

Conclusion: catheter-directed thrombolysis in combination with traditional anticoagulant therapy is a safe and effective method of treatment in patients with acute iliofemoral thrombosis, and allows quickly to restore venous patency and also to reduce risk of development and severity of clinical manifestation of PTD.

References

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2.      Henke PK, Comerota AJ. An update on etiology, prevention, and therapy of postthrombotic syndrome. Journal of Vascular Surgery. 2011; 53: 500-509.

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5.      Comerota AJ, Kamath V. Thrombolysis for iliofemoral deep venous thrombosis. Expert Review of Cardiovascular Therapy. 2013; 12:1631-1638.

6.      Semba CP, Dake MD. Iliofemoral deep venous thrombosis: aggressive therapy with catheter-directed thrombolysis. Radiology. 1994; 191: 487-494.

7.      Vedantham S., Sista A.K., Klein S.J., Nayak L., Razavi M.K., Kalva S.P., et al. Quality Improvement Guidelines for the Treatment of Lower-Extremity Deep Vein Thrombosis with Use of Endovascular Thrombus Removal. Journal of Vascular and Interventional Radiology. 2014; 25: 1317-1325.

8.      Vedantham S, Goldhaber S, Julian J. ATTRACT Trial Investigators. Pharmacomechanical catheter-directed thrombolysis deep-vein thrombosis. N Engl J Med. 2017; 23: 2240-2252.

9.      Kolbel T, Alhadad A, Acosta S, Lindh M, Ivancev K, Gottsдter A. Thrombus Embolization Into IVC Filters During Catheter-Directed Thrombolysis for Proximal Deep Venous Thrombosis. Journal of Endovascular Therapy. 2008; 15: 605-613.

Abstract:

Aim: was to show literature review and personal data on endovascular anatomy of intracranial lesions in patients with acute ischemic stroke.

Material and methods: we present clinical data on endovascular revascularization in patients with ischemic stroke, who were operated in Interregional clinical-diagnostic center for the period 2007-2014.

Results and conclusion: during cerebral angiography, we should estimate arterial, parenchymal and venous phase. Degree of flow recovery after endovascular reperfusion, is estimated on mTICI score. 

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