Feasibility of low-dose digital subtraction angiography protocols for the endovascular treatment of intracranial dural arteriovenous fistulas.
BACKGROUND
Among neurointerventional procedures, the embolization of complex shunt lesions usually requires more radiation dose. We aimed to evaluate the procedural outcome and safety in using low-dose DSA protocols for intracranial dural arteriovenous fistula (AVF) embolization treatment.


METHODS
Between January 2014 and July 2018, 55 patients with dural AVFs who underwent endovascular treatment were included in the study. The low-dose group (n = 27) included from January 2016 used various low-dose DSA protocols made by modifying the thickness of the copper filter or the detector entrance dose. We compared radiation dose metrics, such as air-kerma, kerma-air product (KAP), and fluoroscopy time, as well as clinical and imaging outcomes with the conventional-dose group (n = 28) included before January 2016.


RESULTS
The total KAP was 40.1% lower in the low-dose group (87.9 vs. 146.7 Gy cm2, p = 0.002). The average number of DSA runs (25.1 vs. 25.5, p = 0.86) and fluoroscopy times (77.4 vs. 69.7 min, p = 0.48) were similar between the groups. An immediate favorable occlusion rate (total or near total occlusion) was achieved in 41 (74.5%) patients. Ten patients (18.2%) underwent additional procedures due to residual (n = 6) and/or recurrent (n = 5) lesions. At a median of 10 months follow-up, 45 patients (86.5%) had achieved favorable occlusion. Treatment outcomes showed no significant between-group differences. There was one case (1.8%) of procedure-related complications in the low-dose group. All but one patient showed favorable clinical outcomes (modified Rankin score ≤ 2).


CONCLUSION
The low-dose protocols were feasible by showing significant radiation dose reduction and acceptable procedural outcome.
['Song|Yunsun|Y|', 'Han|Seongsik|S|', 'Kim|Byung Jun|BJ|', 'Oh|Seong Heum|SH|', 'Kim|Jin Su|JS|', 'Kim|Tae Il|TI|', 'Lee|Deok Hee|DH|http://orcid.org/0000-0003-0355-0449']
D015901:Angiography, Digital Subtraction D001164:Arteriovenous Fistula D020785:Central Nervous System Vascular Malformations D004621:Embolization, Therapeutic D057510:Endovascular Procedures D005240:Feasibility Studies D006801:Humans D012189:Retrospective Studies D016896:Treatment Outcome
Angiography Intervention Standards Technique Vascular malformation