First North-American Report on Rampart for Flow Diversion and Radiation Protection

Introduction Radiation exposure is a significant risk during neurointerventional procedures to both the patient, operators, and supporting staff. This concern is especially elevated during embolization procedures, such as flow diversion, which often require prolonged fluoroscopy for device deployment. To date, lead aprons remain standard for radiation protection despite inducing significant physical strain and fatigue. The Rampart system is a lead‐free shielding platform with full‐body protection, aiming to alleviate the physical strain of interventional procedures. The system has previously been used in interventional cardiology procedures, however its use in neurointerventional procedures has not yet been described. We therefore present the first case series describing Rampart use in flow diversion procedures, including measured operator radiation exposure. Methods A prospectively maintained database of radiation data was built for all Rampart cases at a single institution. Geiger meters were strategically positioned in seven predefined locations within the operating room, including the primary and secondary physicians, rotating nurse, and anesthesiologist. The control Geiger badge is placed on the patient near their head to measure maximum radiation exposure. Radiation measurements were entered into the database immediately following intervention. The database was later queried retrospectively for analysis. Results A total of four cases of flow diversion were done using the Rampart system. Recorded radiation doses for control was 191.6 ± 130.5 mRem, with the Geiger meter on the physician recording average of 0.067 ± 0.06 mRem, and anesthesia recording 0.07 ± 0.12 mRem. These values were compared to our control cases with traditional shielding and leaded aprons.. A total of two flow diversion cases were done without the Rampart system, and the recorded radiation was 312.6 ± 77.5 mRem for control, 1.4 ± 1.0 mRem for the operating physician, and 0.35 ± 0.4 mRem for the anesthesiologist. The use of the Rampart system was able to nearly eliminate radiation in the neurointerventional suite. Even with the notably low radiation levels of the traditional system at this institution, the Rampart system reduced these levels by 95% for the operating physician and 81% for the anesthesiologist. Conclusion Rampart technology provides excellent full‐body radiation protection during flow diversion procedures without the associated physical burden of lead aprons and the occupational health hazard from radiation exposure. In this limited study, Rampart technology did not interfere with any aspect of the procedures, such as device deployment and patient access. Larger studies are recommended to evaluate the effectiveness of Rampart across all endovascular procedures.