Abstract / Summary
Objectives: Systematically evaluating radiation exposure during mechanical thrombectomy (MT) for acute endovascular stroke treatment at a high-volume centre to generate evidence to evaluate diagnostic reference levels (DRLs) and to support strategies for radiation dose optimization. Methods: Demographic (age, sex, body mass index), procedural (technical approach, number of passes), dosimetric (dose–area product [DAP], fluoroscopy time, number of acquisition series), and anatomical parameters were retrospectively analyzed in a cohort of 390 patients undergoing mechanical thrombectomy on a biplane flat-panel detector system using a standardized workflow and a dedicated low-dose protocol. Nonparametric statistical methods as well as univariate and multivariate regression were used, and p-values <0.05 were considered statistically significant. Results: Median total DAP was 4741.33 cGy·cm2, with fluoroscopy contributing approximately 51% of the total dose. In the multivariable regression analysis, the number of thrombectomy passes, fluoroscopy time, and number of imaging series were independent predictors of increased radiation exposure. In univariable analyses, radiation exposure was significantly associated with procedural duration, recanalization time, and BMI (all p < 0.001). Greater procedural complexity, including combined thrombectomy techniques (p = 0.02) and adjunctive stenting (p < 0.001), was associated with higher DAP but was not independently predictive in the multivariable model. In contrast, anatomical and demographic factors had a limited impact: stroke location (anterior versus posterior circulation), laterality, and age were not significantly associated with radiation exposure, whereas distal occlusions (p < 0.001) and female gender (p < 0.001) were associated with lower DAP. Conclusions: Mechanical thrombectomy for acute endovascular stroke treatment can be performed with low radiation exposure using standardized workflows, optimized low-dose protocols, dose-reduction technologies, and, where feasible, monoplane imaging. Procedural rather than anatomical or demographic factors drive radiation exposure.