Radiation Exposure in Elective Endovascular Carotid Artery Stenting

OBJECTIVES: To systematically assess radiation exposure during elective carotid artery stenting (CAS) for symptomatic extracranial carotid stenosis at a high-volume centre and to generate data that support optimization of both radiation dose and procedural workflow, thereby providing a basis for future multicentre studies aimed at establishing diagnostic reference levels. METHODS: Demographic (age, gender, BMI), procedural (balloon dilatations, procedure time), dosimetric (dose-area product [DAP], fluoroscopy time, number of acquisition series), anatomical, and interventionalist-related factors were retrospectively analysed in 109 patients undergoing CAS on a biplane flat-panel system using a standardized workflow and dedicated low-dose protocol. Nonparametric statistics were applied; p < 0.05 was considered significant. Gender, anatomical side, and stenosis characteristics had no significant impact, whereas age and BMI were positively associated with total DAP (p = 0.047 and 0.014). Total DAP correlated with procedure time (rₛ = 0.491, p < 0.001), fluoroscopy time (rₛ = 0.666, p < 0.001), and number of acquisition series (rₛ = 0.364, p < 0.001). Plane A was used more frequently than plane B (p < 0.001). Procedures performed by the senior interventionalist (> 20 years experience) showed significantly lower fluoroscopy DAP (p = 0.004), shorter procedure and fluoroscopy times, and fewer acquisition series. CONCLUSIONS: Elective CAS can be performed with low radiation exposure using standardized workflows and low-dose imaging. Radiation exposure is influenced by patient characteristics, procedural factors, and interventionalist experience. These data may provide a foundation for future multicentre studies aimed at establishing DRLs and optimizing dose-reduction strategies in neuroendovascular practice.