Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Eur Radiol. 2020 Mar;30(3):1564-1570. doi: 10.1007/s00330-019-06482-4. Epub 2019 Nov 11.
To quantify the influence of interventionalist's experience on procedure time, radiation exposure, and fluoroscopy time during mechanical thrombectomy (MT) in the anterior circulation.
Retrospective analysis of an institutional review board-approved stroke database of a comprehensive stroke center focusing on radiation exposure (as per dose area product in Gy × cm, median [IQR]), procedure, and fluoroscopy time (in minutes, median [IQR]) in patients receiving MT in anterior circulation ischemic stroke. Procedures have been assigned according to the interventionalist's experience in MT into three sequential groups: A = 1-25 procedures, B = 26-50 procedures, and C = more than 50 procedures.
Overall, 696 patients have been included in this analysis (A, n = 152; B, n = 151; C, n = 393). Procedure times (A, 86 [54-131]; B, 67 [48-103], p value 0.006), fluoroscopy times (A, 39 [25-72]; B, 32 [20-53], p value 0.001) as well as radiation exposure (A, 148.13 [89.58-243.37]; B, 111.60 [70.49-180.57], p value 0.001) were significantly shorter, respectively lower in group B than in group A. Procedure times (C, 59 [36-99]), fluoroscopy times (C, 31 [16-53]), and radiation exposure (C, 113.91 [68.48-182.88]) in group C were also significantly shorter/lower than in group A (all p values < 0.0001), but comparable with group B (p values 0.071, 0.809, and 0.934).
This retrospective analysis demonstrates a significant influence of interventionalist's experience on procedure time, fluoroscopy time, and radiation exposure in mechanical thrombectomy in the anterior circulation.
• There is a significant influence of interventionalist's experience on procedure time, fluoroscopy time, and radiation exposure in mechanical thrombectomy in the anterior circulation. • Interventionalists' learning curve is steepest during the first 25 cases. • These circumstances should be considered when reference levels or guide values are established and in training of physicians performing mechanical thrombectomy to promote optimization of patient doses in the future.
定量分析介入医师经验对机械血栓切除术（MT）前循环中手术时间、辐射暴露和透视时间的影响。
对一家综合卒中中心的机构审查委员会批准的卒中数据库进行回顾性分析，该数据库重点关注辐射暴露（按剂量面积乘积[Gy×cm]，中位数[IQR]）、手术和透视时间（以分钟计，中位数[IQR]），并在接受前循环缺血性卒中 MT 的患者中进行。根据介入医师在 MT 中的经验，将手术分为三个连续组：A=1-25 例，B=26-50 例，C=50 例以上。
总体而言，共有 696 例患者纳入本分析（A 组：152 例；B 组：151 例；C 组：393 例）。手术时间（A 组：86[54-131]；B 组：67[48-103]，p 值=0.006）、透视时间（A 组：39[25-72]；B 组：32[20-53]，p 值=0.001）以及辐射暴露（A 组：148.13[89.58-243.37]；B 组：111.60[70.49-180.57]，p 值=0.001）均显著缩短，B 组明显低于 A 组。C 组（n=393）的手术时间（C 组：59[36-99]）、透视时间（C 组：31[16-53]）和辐射暴露（C 组：113.91[68.48-182.88]）均显著短于 A 组（所有 p 值均<0.0001），但与 B 组相当（p 值分别为 0.071、0.809 和 0.934）。
这项回顾性分析表明，介入医师经验在前循环机械血栓切除术的手术时间、透视时间和辐射暴露方面有显著影响。
介入医师经验在前循环机械血栓切除术的手术时间、透视时间和辐射暴露方面有显著影响。
介入医师的学习曲线在前 25 例中最为陡峭。
在制定参考水平或指导值以及培训进行机械血栓切除术的医生时，应考虑到这些情况，以促进未来患者剂量的优化。
