Introduction A number of radiolucent head immobilization devices are available for use in the neurovascular space claiming to provide increased procedural efficiency and angiographic image quality, however, limited data exists to support these claims. In addition, no data exists for two of the most important factors to the neurointevenionalist—radiation exposure and procedural times. The aim of this retrospective study was to assess the benefit of using radiolucent head immobilization in neurovascular procedures with specific focus on image quality, radiation exposure and procedural times.

Materials and Methods Consecutive patients treated at a single center by a single physician undergoing cerebral digital subtraction angiography (DSA) or middle meningeal artery embolization (MMAE) under conscious sedation between January 1, 2023 and February 1, 2024 were included. Patient demographics, procedural data and radiographic data were collected and compared before and after regular use of a radiolucent head immobilizer (RHI) (Adept Medical, Auckland, NZ). Angiographic images captured during DSA underwent blinded quality assessment by two fellowship-trained neuroradiologists.

Results Digital Subtraction Angiography The DSA arm included 69 patients with 32 patients in the post-RHI cohort. Mean ages were 61.3 and 53 in the pre- and post-RHI cohorts, respectively (p < .05), and use of radial access was similar across cohorts. Cerebral angiograms completed post-RHI demonstrated significantly decreased mean fluoroscopy time per vessel compared to patients pre-RHI, 2.5 versus 3.1 minutes per vessel respectively (p < .05). No difference was found in radiation dose across cohorts. Blinded image quality comparison demonstrated no difference between image quality and presence of artifact between cohorts. Middle Meningeal Artery Embolization The MMAE arm included 39 patients with 19 patients in the post-RHI cohort. No significant differences were identified in age or use of radial access. No significant difference in fluoroscopy time was identified in patients undergoing unilateral MMAE. However, patients undergoing bilateral embolization post-RHI demonstrated significantly decreased fluoroscopy times compared to pre-RHI, 40.6 minutes and 50.6 minutes, respectively (p < .05). No difference was found in radiation dose across cohorts.

Conclusion In this retrospective analysis of neurointerventional procedures, use of radiolucent head immobilization was associated with significantly lower fluoroscopy times for cerebral angiography and bilateral MMA embolization with no identified loss of image quality. These findings suggest that radiolucent head immobilization may prove beneficial for decreasing procedural times, particularly during longer conscious sedation procedures. In this experience, decrease in fluoroscopy times did not correlate with a decrease in overall radiation exposure.

Disclosures N. Lam: None. W. Ares: None.