Comparison of mono versus biplane performance and factors associated with higher radiation doses and contrast exposure during cerebrovascular mechanical thrombectomy, an international multi-centers study

Background To compare efficacy and safety of mechanical thrombectomy (MT) depending on mono versus biplane angioroom (AR), radiation exposure, contrast dose, procedure duration for acute ischemic stroke with large vessel occlusion (AISLVO) according to procedural factors. To realize a systematic literature review on the single/biplane comparison. Materials and methods Between January 2014 and May 2017, 906 consecutive patients from 3 countries with all available data underwent a MT in four centers: – 330 on a single-plane (SP); – 576 on a biplane; – data were retrospectively analyzed. Efficacy and safety characteristics, radiation dose, contrast load and fluoroscopy duration were analyzed and compared depending on clinical and procedural factors of the AR. Results After multivariate analysis, only contrast load (50% lower) and scopy duration (19% lower) remained significantly lower on biplane versus monoplane. There was no difference concerning procedure duration, radiation doses, rate of successful recanalization, outcome and complication between MP and biplane, Philips and Siemens after multivariate analyses. Among other factors, general anaesthesia was associated with higher DAP, Kerma, contrast load. Performing an angiogram before MT was associated with increased procedure duration (15% increase), DAP (33% increase), contrast load (125% increase) on univariate analyses. Conclusion Both AR seem to be equivalent in terms of safety and effectiveness for MT. Biplane equipment drastically reduces contrast load. The decision to realize an angiogram before a MT should be clinically motivated because of increased radiation, contrast doses and procedure duration.