Neurointervention.  2016 Sep;11(2):105-113. 10.5469/neuroint.2016.11.2.105.

Monoplane 3D Overlay Roadmap versus Conventional Biplane 2D Roadmap Technique for Neurointervenional Procedures

• Jang DK
• Stidd DA
• Schafer S
• Chen M
• Moftakhar
• Lopes DK

• KMID: 2350688
• DOI: http://doi.org/10.5469/neuroint.2016.11.2.105

Abstract

PURPOSE
We investigated whether a 3D overlay roadmap using monoplane fluoroscopy offers advantages over a conventional 2D roadmap using biplane fluoroscopy during endovascular aneurysm treatment.
MATERIALS AND METHODS
A retrospective chart review was conducted for 131 consecutive cerebral aneurysm embolizations by three neurointerventionalists at a single institution. Allowing for a transition period, the periods from January 2012 to August 2012 (Time Period 1) and February 2013 to July 2013 (Time Period 2) were analyzed for radiation exposure, contrast administration, fluoroscopy time, procedure time, angiographic results, and perioperative complications. Two neurointerventionalists (Group 1) used a conventional 2D roadmap for both Time Periods, and one neurointerventionalist (Group 2) transitioned from a 2D roadmap during Time Period 1 to a 3D overlay roadmap during Time Period 2.
RESULTS
During Time Period 2, Group 2 demonstrated reduced fluoroscopy time (p<0.001), procedure time (P=0.023), total radiation dose (p=0.001), and fluoroscopy dose (P=0.017) relative to Group 1. During Time Period 2, there was no difference of immediate angiographic results and procedure complications between the two groups. Through the transition from Time Period 1 to Time Period 2, Group 2 demonstrated decreased fluoroscopy time (p<0.001), procedure time (p=0.022), and procedure complication rate (p=0.041) in Time Period 2 relative to Time Period 1.
CONCLUSION
The monoplane 3D overlay roadmap technique reduced fluoroscopy dose and fluoroscopy time during neurointervention of cerebral aneurysms with similar angiographic occlusions and complications rate relative to biplane 2D roadmap, which implies possible compensation of limitations of monoplane fluoroscopy by 3D overlay technique.

Keyword

3D roadmap; Aneurysms; Neurointervention; Fluoroscopy dose; Fluoroscopy time

MeSH Terms

Aneurysm
Compensation and Redress
Fluoroscopy
Intracranial Aneurysm
Radiation Exposure
Retrospective Studies

Figure

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  Fig. 1 Stent-assisted coil embolization of a basilar terminus aneurysm using a 3D overlay roadmap technique with monoplane fluoroscopy. After an endoluminal stent was deployed from the left posterior cerebral artery P1 segment into the distal basilar artery, a microcatheter was navigated into the aneurysm using a 3D overlay roadmap (A). Coils were deployed into the aneurysm using a blank roadmap technique and a 3D stent reconstruction overlay (B).

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