Pub Date : 2023-02-01DOI: 10.1016/j.jimed.2022.07.003
Xi Chen , Liang Ge , Hailin Wan, Lei Huang, Yeqing Jiang, Gang Lu, Jing Wang, Xiaolong Zhang
A dural arteriovenous fistula (DAVF) is an abnormal linkage connecting the arterial and venous systems within the intracranial dura mater. A basicranial emissary vein DAVF drains into the cavernous sinus and the ophthalmic vein, similar to a cavernous sinus DAVF. Precise preoperative identification of the DAVF location is a prerequisite for appropriate treatment. Treatment options include microsurgical disconnection, endovascular transarterial embolization (TAE), transvenous embolization (TVE), or a combination thereof. TVE is an increasingly popular approach for the treatment of DAVFs and the preferred approach for skull base locations, due to the risk of cranial neuropathy caused by dangerous anastomosis from arterial approaches. Multimodal magnetic resonance imaging (MRI) can provide anatomical and hemodynamic information for TVE. The therapeutic target must be precisely embolized in the emissary vein, which requires guidance via multimodal MRI. Here, we report a rare case of successful TVE for a basicranial emissary vein DAVF, utilizing multimodal MRI assistance. The fistula had vanished, pterygoid plexus drainage had improved, and the inferior petrosal sinus had recanalized, as observed on 8-month follow-up angiography. Symptoms and signs of double vision, caused by abduction deficiency, disappeared. Detailed anatomic and hemodynamic assessment by multimodal MRI is the key to guiding successful diagnosis and treatment.
{"title":"Multimodal MRI diagnosis and transvenous embolization of a basicranial emissary vein dural arteriovenous fistula: A case report","authors":"Xi Chen , Liang Ge , Hailin Wan, Lei Huang, Yeqing Jiang, Gang Lu, Jing Wang, Xiaolong Zhang","doi":"10.1016/j.jimed.2022.07.003","DOIUrl":"10.1016/j.jimed.2022.07.003","url":null,"abstract":"<div><p>A dural arteriovenous fistula (DAVF) is an abnormal linkage connecting the arterial and venous systems within the intracranial dura mater. A basicranial emissary vein DAVF drains into the cavernous sinus and the ophthalmic vein, similar to a cavernous sinus DAVF. Precise preoperative identification of the DAVF location is a prerequisite for appropriate treatment. Treatment options include microsurgical disconnection, endovascular transarterial embolization (TAE), transvenous embolization (TVE), or a combination thereof. TVE is an increasingly popular approach for the treatment of DAVFs and the preferred approach for skull base locations, due to the risk of cranial neuropathy caused by dangerous anastomosis from arterial approaches. Multimodal magnetic resonance imaging (MRI) can provide anatomical and hemodynamic information for TVE. The therapeutic target must be precisely embolized in the emissary vein, which requires guidance via multimodal MRI. Here, we report a rare case of successful TVE for a basicranial emissary vein DAVF, utilizing multimodal MRI assistance. The fistula had vanished, pterygoid plexus drainage had improved, and the inferior petrosal sinus had recanalized, as observed on 8-month follow-up angiography. Symptoms and signs of double vision, caused by abduction deficiency, disappeared. Detailed anatomic and hemodynamic assessment by multimodal MRI is the key to guiding successful diagnosis and treatment.</p></div>","PeriodicalId":33533,"journal":{"name":"Journal of Interventional Medicine","volume":"6 1","pages":"Pages 41-45"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bb/1b/main.PMC10167501.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9467637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01DOI: 10.1016/j.jimed.2022.10.003
Zhuofan Deng, Yunbing Wang
Background
Spontaneously ruptured hepatocellular carcinoma (rHCC) is a life-threatening condition. Transarterial chemoembolization (TACE) is a widely accepted treatment; however, it can lead to serious complications, especially liver failure. We sought to identify preoperative predictors of liver failure in patients with rHCC undergoing TACE.
Methods
Patients with rHCC who received TACE as the initial therapy were retrospectively studied at our institution between January 2016 and December 2021. Based on the occurrence of liver failure after TACE, the patients were divided into liver failure and no-liver failure groups. Predictors of liver failure after TACE were analyzed using univariate and multivariate regression analyses. The predictive performance was assessed using the area under the curve (AUC). Delong's test was used to compare predictive efficiency.
Results
Sixty patients (19 and 41 in the liver failure and non-liver failure groups, respectively) were included. Multivariate analysis showed that preoperative prothrombin activity (PTA) level (odds ratio [OR], 0.956; 95% confidence interval [CI], 0.920–0.994; P = 0.024) and Child-Pugh grade B (OR, 6.419; 95% CI, 1.123–36.677; P = 0.037) were independent predictors of liver failure after TACE in patients with rHCC. The AUCs of the preoperative PTA levels and Child-Pugh grade B for predicting liver failure after TACE in patients with rHCC were 0.783 and 0.764, respectively.
Conclusion
Preoperative PTA level and Child-Pugh grade B were significant independent risk factors for liver failure after TACE in patients with rHCC. These can be used to predict liver failure after TACE in patients with rHCC for individual decision-making regarding treatment planning.
{"title":"Predictors of liver failure after transarterial chemoembolization in patients with spontaneously ruptured hepatocellular carcinoma: A retrospective study","authors":"Zhuofan Deng, Yunbing Wang","doi":"10.1016/j.jimed.2022.10.003","DOIUrl":"10.1016/j.jimed.2022.10.003","url":null,"abstract":"<div><h3>Background</h3><p>Spontaneously ruptured hepatocellular carcinoma (rHCC) is a life-threatening condition. Transarterial chemoembolization (TACE) is a widely accepted treatment; however, it can lead to serious complications, especially liver failure. We sought to identify preoperative predictors of liver failure in patients with rHCC undergoing TACE.</p></div><div><h3>Methods</h3><p>Patients with rHCC who received TACE as the initial therapy were retrospectively studied at our institution between January 2016 and December 2021. Based on the occurrence of liver failure after TACE, the patients were divided into liver failure and no-liver failure groups. Predictors of liver failure after TACE were analyzed using univariate and multivariate regression analyses. The predictive performance was assessed using the area under the curve (AUC). Delong's test was used to compare predictive efficiency.</p></div><div><h3>Results</h3><p>Sixty patients (19 and 41 in the liver failure and non-liver failure groups, respectively) were included. Multivariate analysis showed that preoperative prothrombin activity (PTA) level (odds ratio [OR], 0.956; 95% confidence interval [CI], 0.920–0.994; <em>P</em> = 0.024) and Child-Pugh grade B (OR, 6.419; 95% CI, 1.123–36.677; <em>P</em> = 0.037) were independent predictors of liver failure after TACE in patients with rHCC. The AUCs of the preoperative PTA levels and Child-Pugh grade B for predicting liver failure after TACE in patients with rHCC were 0.783 and 0.764, respectively.</p></div><div><h3>Conclusion</h3><p>Preoperative PTA level and Child-Pugh grade B were significant independent risk factors for liver failure after TACE in patients with rHCC. These can be used to predict liver failure after TACE in patients with rHCC for individual decision-making regarding treatment planning.</p></div>","PeriodicalId":33533,"journal":{"name":"Journal of Interventional Medicine","volume":"6 1","pages":"Pages 35-40"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1b/4f/main.PMC10167498.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9472953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.1016/j.jimed.2022.09.003
Huan Liu , Yanyan He , Tengfei Zhou , Liangfu Zhu , Yao Zhao , Yonghong Ding , Yingkun He , Tianxiao Li
Background and purpose
Stent retriever thrombectomy is the standard therapeutic approach for ischemic stroke with acute large-vessel occlusion. This study evaluated the safety and efficacy of a new thrombectomy device (Skyflow) in the treatment of acute ischemic stroke.
Methods
After an arterial occlusion model was established, stent-retriever thrombectomy was performed. Digital subtraction angiography (DSA) and autopsy were carried out immediately after thrombectomy in six animals in the acute experimental group. Simulated stent-retriever thrombectomy was performed for three animals in the subacute experimental group, and follow-up angiography and vascular pathological examination were assessed 90 days after the operation. In the clinical trial, 192 patients with intracranial anterior circulation large vessel occlusion, within 8 h of symptom onset, were included to undergo thrombectomy with either Skyflow or Solitaire FR stent retriever. Efficacy and safety endpoints were recorded (including successful reperfusion, favorable clinical outcomes, time from puncture to reperfusion, instrument operation success rates and National Institutes of Health Stroke Scale (NIHSS) scores at 7 days for efficacy endpoints, and symptomatic intracranial hemorrhage (sICH), subarachnoid hemorrhage (SAH) and all-cause mortality rates for safety endpoints).
Results
All blood vessels achieved successful recanalization in the animal models. In the clinical trial, successful recanalization was attained in 88.4% of patients of the Skyflow group, which was comparable to that of the Solitaire FR group (82.5%) in the full analysis set of the clinical trial. There were no severe complications on DSA, an animal autopsy, or vessel pathological examination in animal experiments. Additionally, no statistically significant difference was observed between the Skyflow and Solitaire FR groups in the clinical trial regarding the safety endpoints.
Conclusion
This study showed that the new Skyflow stent retriever is safe and effective for the treatment of acute large vessel occlusion, as demonstrated in our animal study and human trial.
{"title":"Evaluation of using a double helical, closed-cell stent-retriever (Skyflow) for thrombectomy procedures in acute arterial occlusion: A preclinical study and a clinical trial","authors":"Huan Liu , Yanyan He , Tengfei Zhou , Liangfu Zhu , Yao Zhao , Yonghong Ding , Yingkun He , Tianxiao Li","doi":"10.1016/j.jimed.2022.09.003","DOIUrl":"10.1016/j.jimed.2022.09.003","url":null,"abstract":"<div><h3>Background and purpose</h3><p>Stent retriever thrombectomy is the standard therapeutic approach for ischemic stroke with acute large-vessel occlusion. This study evaluated the safety and efficacy of a new thrombectomy device (Skyflow) in the treatment of acute ischemic stroke.</p></div><div><h3>Methods</h3><p>After an arterial occlusion model was established, stent-retriever thrombectomy was performed. Digital subtraction angiography (DSA) and autopsy were carried out immediately after thrombectomy in six animals in the acute experimental group. Simulated stent-retriever thrombectomy was performed for three animals in the subacute experimental group, and follow-up angiography and vascular pathological examination were assessed 90 days after the operation. In the clinical trial, 192 patients with intracranial anterior circulation large vessel occlusion, within 8 h of symptom onset, were included to undergo thrombectomy with either Skyflow or Solitaire FR stent retriever. Efficacy and safety endpoints were recorded (including successful reperfusion, favorable clinical outcomes, time from puncture to reperfusion, instrument operation success rates and National Institutes of Health Stroke Scale (NIHSS) scores at 7 days for efficacy endpoints, and symptomatic intracranial hemorrhage (sICH), subarachnoid hemorrhage (SAH) and all-cause mortality rates for safety endpoints).</p></div><div><h3>Results</h3><p>All blood vessels achieved successful recanalization in the animal models. In the clinical trial, successful recanalization was attained in 88.4% of patients of the Skyflow group, which was comparable to that of the Solitaire FR group (82.5%) in the full analysis set of the clinical trial. There were no severe complications on DSA, an animal autopsy, or vessel pathological examination in animal experiments. Additionally, no statistically significant difference was observed between the Skyflow and Solitaire FR groups in the clinical trial regarding the safety endpoints.</p></div><div><h3>Conclusion</h3><p>This study showed that the new Skyflow stent retriever is safe and effective for the treatment of acute large vessel occlusion, as demonstrated in our animal study and human trial.</p></div>","PeriodicalId":33533,"journal":{"name":"Journal of Interventional Medicine","volume":"5 4","pages":"Pages 190-195"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2b/0b/main.PMC9751221.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10750256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.1016/j.jimed.2022.04.001
Gang Luo , Shuai Gao , Hongxiao Sun , Zhixian Ji , Dunliang Wang , Yue Sun , Silin Pan
Objective
This study aimed to analyze and evaluate the results of mid-term follow-up after fetal pulmonary valvuloplasty (FPV) in fetuses with pulmonary atresia with intact ventricular septum (PA/IVS).
Methods
From August 31, 2018, to May 31, 2019, seven fetuses with PA/IVS and hypoplastic right heart were included in this study. All underwent echocardiography by the same specialist and were operated on by the same team. Intervention and echocardiography data were collected, and changes in the associated indices noted during follow-up were analyzed.
Results
All seven fetuses successfully underwent FPV. The median gestational age at FPV was 27.54 weeks. The average FPV procedural time was 6 min. Persistent bradycardia requiring treatment occurred in 4/7 procedures. Finally, five pregnancies were successfully delivered, and the other two were aborted. Compared to data before fetal cardiac interventions (FCI), tricuspid valve annulus diameter/mitral valve annulus diameter (TV/MV) and right ventricle diameter/left ventricle diameter (RV/LV) of all fetuses had progressively improved. The maximum tricuspid regurgitation velocity decreased from 4.60 m/s to 3.64 m/s. The average follow-up time was 30.40 ± 2.05 months. During the follow-up period, the diameter of the tricuspid valve ring in five children continued to improve, and the development rate of the tricuspid valve was relatively obvious from 6 months to 1 year after birth. However, the development of the right ventricle after birth was relatively slow. It was discovered that there were individual variations in the development of the right ventricle during follow-up.
Conclusion
The findings support the potential for the development of the right ventricle and tricuspid valve in fetuses with PA/IVS who underwent FCI. Development of the right ventricle and tricuspid valve does not occur synchronously during pregnancy. The right ventricle develops rapidly in utero, but the development of tricuspid valve is more apparent after birth than in utero.
{"title":"Valvuloplasty of fetal pulmonary atresia with intact ventricular septum and hypoplastic right heart: Mid-term follow-up results","authors":"Gang Luo , Shuai Gao , Hongxiao Sun , Zhixian Ji , Dunliang Wang , Yue Sun , Silin Pan","doi":"10.1016/j.jimed.2022.04.001","DOIUrl":"10.1016/j.jimed.2022.04.001","url":null,"abstract":"<div><h3>Objective</h3><p>This study aimed to analyze and evaluate the results of mid-term follow-up after fetal pulmonary valvuloplasty (FPV) in fetuses with pulmonary atresia with intact ventricular septum (PA/IVS).</p></div><div><h3>Methods</h3><p>From August 31, 2018, to May 31, 2019, seven fetuses with PA/IVS and hypoplastic right heart were included in this study. All underwent echocardiography by the same specialist and were operated on by the same team. Intervention and echocardiography data were collected, and changes in the associated indices noted during follow-up were analyzed.</p></div><div><h3>Results</h3><p>All seven fetuses successfully underwent FPV. The median gestational age at FPV was 27.54 weeks. The average FPV procedural time was 6 min. Persistent bradycardia requiring treatment occurred in 4/7 procedures. Finally, five pregnancies were successfully delivered, and the other two were aborted. Compared to data before fetal cardiac interventions (FCI), tricuspid valve annulus diameter/mitral valve annulus diameter (TV/MV) and right ventricle diameter/left ventricle diameter (RV/LV) of all fetuses had progressively improved. The maximum tricuspid regurgitation velocity decreased from 4.60 m/s to 3.64 m/s. The average follow-up time was 30.40 ± 2.05 months. During the follow-up period, the diameter of the tricuspid valve ring in five children continued to improve, and the development rate of the tricuspid valve was relatively obvious from 6 months to 1 year after birth. However, the development of the right ventricle after birth was relatively slow. It was discovered that there were individual variations in the development of the right ventricle during follow-up.</p></div><div><h3>Conclusion</h3><p>The findings support the potential for the development of the right ventricle and tricuspid valve in fetuses with PA/IVS who underwent FCI. Development of the right ventricle and tricuspid valve does not occur synchronously during pregnancy. The right ventricle develops rapidly in utero, but the development of tricuspid valve is more apparent after birth than in utero.</p></div>","PeriodicalId":33533,"journal":{"name":"Journal of Interventional Medicine","volume":"5 4","pages":"Pages 196-199"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d9/1b/main.PMC9751216.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10460768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.1016/j.jimed.2022.09.004
Guo Yuan How, Uei Pua
Hepatocellular carcinoma (HCC) is the second most lethal tumour, with therapies broadly divided into curative and palliative intent. Unfortunately, the majority of HCCs were found to be unresectable at diagnosis. Advances in novel loco-regional therapies have given patients with unresectable HCC a vital chance for disease control and survival. However, the COVID-19 pandemic has greatly shaped and impacted treatment protocols and delivery for HCC patients. This review article aims to describe the impact of the COVID-19 pandemic on the delivery of loco-regional treatment modalities for HCC and compare treatment trends between the pre -pandemic and pandemic eras. Treatment of HCC involves complex collaboration between clinical professionals within their local and global healthcare institutions. The COVID-19 pandemic has had a profound impact on the treatment of HCC. The delivery of loco-regional treatment for HCC will need to adapt to each healthcare system's unique structure.
{"title":"Impact and the delivery of loco-regional treatment for hepatocellular carcinoma during the COVID-19 pandemic","authors":"Guo Yuan How, Uei Pua","doi":"10.1016/j.jimed.2022.09.004","DOIUrl":"10.1016/j.jimed.2022.09.004","url":null,"abstract":"<div><p>Hepatocellular carcinoma (HCC) is the second most lethal tumour, with therapies broadly divided into curative and palliative intent. Unfortunately, the majority of HCCs were found to be unresectable at diagnosis. Advances in novel loco-regional therapies have given patients with unresectable HCC a vital chance for disease control and survival. However, the COVID-19 pandemic has greatly shaped and impacted treatment protocols and delivery for HCC patients. This review article aims to describe the impact of the COVID-19 pandemic on the delivery of loco-regional treatment modalities for HCC and compare treatment trends between the pre -pandemic and pandemic eras. Treatment of HCC involves complex collaboration between clinical professionals within their local and global healthcare institutions. The COVID-19 pandemic has had a profound impact on the treatment of HCC. The delivery of loco-regional treatment for HCC will need to adapt to each healthcare system's unique structure.</p></div>","PeriodicalId":33533,"journal":{"name":"Journal of Interventional Medicine","volume":"5 4","pages":"Pages 180-183"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/78/c0/main.PMC9751215.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10749783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic occlusion of large intracranial arteries is the main cause of ischemic stroke in China. Patients with symptomatic intracranial artery occlusion and hemodynamic impairment are at high risk of recurrent stroke. Chronic occlusion of the intracranial segment of the internal carotid artery is a common type of intracranial artery occlusion. Medical management is regarded as the standard treatment for this disease. With the development of endovascular treatment, some patients with chronic cerebral artery occlusion have achieved satisfactory results with endovascular therapy. We reported a patient with symptomatic chronic occlusion of the ophthalmic segment of the internal carotid artery. Simple balloon angioplasty was performed, and the occluded ophthalmic segment of the internal carotid artery was successfully recanalized without perioperative complications. At 4 months follow-up, the internal carotid artery remained patent and perfusion of the right cerebral hemisphere improved dramatically. In addition, we briefly reviewed the relevant literature.
{"title":"Primary balloon angioplasty for chronic occlusion of intracranial internal carotid artery: A case report","authors":"Tianli Li, Zhaolong Zhang, Chengjian Sun, Guoping Liu, Xiaolong Zhao, Liming Shao, Xuan Zheng, Yixing Xie, Changxin Wang, Rui Xu","doi":"10.1016/j.jimed.2022.07.001","DOIUrl":"10.1016/j.jimed.2022.07.001","url":null,"abstract":"<div><p>Chronic occlusion of large intracranial arteries is the main cause of ischemic stroke in China. Patients with symptomatic intracranial artery occlusion and hemodynamic impairment are at high risk of recurrent stroke. Chronic occlusion of the intracranial segment of the internal carotid artery is a common type of intracranial artery occlusion. Medical management is regarded as the standard treatment for this disease. With the development of endovascular treatment, some patients with chronic cerebral artery occlusion have achieved satisfactory results with endovascular therapy. We reported a patient with symptomatic chronic occlusion of the ophthalmic segment of the internal carotid artery. Simple balloon angioplasty was performed, and the occluded ophthalmic segment of the internal carotid artery was successfully recanalized without perioperative complications. At 4 months follow-up, the internal carotid artery remained patent and perfusion of the right cerebral hemisphere improved dramatically. In addition, we briefly reviewed the relevant literature.</p></div>","PeriodicalId":33533,"journal":{"name":"Journal of Interventional Medicine","volume":"5 4","pages":"Pages 213-216"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5b/a6/main.PMC9751220.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10749786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.1016/j.jimed.2022.04.004
Xi Chen , Liang Ge , Hailin Wan, Lei Huang, Yeqing Jiang, Gang Lu, Xiaolong Zhang
Dural arteriovenous fistulas (DAVFs) include a wide range of pathological conditions that are associated with intracranial vessel abnormalities. While some types of DAVFs present with typical neuroimaging characteristics, others share overlapping pathological and neuroimaging features that can hinder accurate differentiation. Hence, misclassification of the various types of DAVFs is common. Thorough knowledge of DAVF imaging findings is essential to avoid such misinterpretations. Traditional digital subtraction angiography (DSA) is considered the gold standard for diagnosing and evaluating DAVFs. However, angiography cannot detect changes in a patient's brain structure. Conventional magnetic resonance imaging (MRI) sequences, including MR angiography (MRA), allow the evaluation of DAVFs without ionizing radiation or invasiveness. Advanced MRI techniques, such as susceptibility-weighted imaging (SWI) and dynamic contrast-enhanced MRA, provide added value to real-time physio-pathological data regarding the hemodynamics of DAVFs. Beyond these techniques, new insights using high-resolution vascular wall MRI are incorporated for the noninvasive evaluation of DAVFs. This article reviews the pathophysiology of DAVFs, focusing on the specifics of MRI findings that facilitate their classification. The role of conventional and advanced MRI sequences for DAVFs was assessed using insights derived from the data provided by structured reports of multimodal MRIs to evaluate DAVFs.
{"title":"Overview of multimodal MRI of intracranial Dural arteriovenous fistulas","authors":"Xi Chen , Liang Ge , Hailin Wan, Lei Huang, Yeqing Jiang, Gang Lu, Xiaolong Zhang","doi":"10.1016/j.jimed.2022.04.004","DOIUrl":"10.1016/j.jimed.2022.04.004","url":null,"abstract":"<div><p>Dural arteriovenous fistulas (DAVFs) include a wide range of pathological conditions that are associated with intracranial vessel abnormalities. While some types of DAVFs present with typical neuroimaging characteristics, others share overlapping pathological and neuroimaging features that can hinder accurate differentiation. Hence, misclassification of the various types of DAVFs is common. Thorough knowledge of DAVF imaging findings is essential to avoid such misinterpretations. Traditional digital subtraction angiography (DSA) is considered the gold standard for diagnosing and evaluating DAVFs. However, angiography cannot detect changes in a patient's brain structure. Conventional magnetic resonance imaging (MRI) sequences, including MR angiography (MRA), allow the evaluation of DAVFs without ionizing radiation or invasiveness. Advanced MRI techniques, such as susceptibility-weighted imaging (SWI) and dynamic contrast-enhanced MRA, provide added value to real-time physio-pathological data regarding the hemodynamics of DAVFs. Beyond these techniques, new insights using high-resolution vascular wall MRI are incorporated for the noninvasive evaluation of DAVFs. This article reviews the pathophysiology of DAVFs, focusing on the specifics of MRI findings that facilitate their classification. The role of conventional and advanced MRI sequences for DAVFs was assessed using insights derived from the data provided by structured reports of multimodal MRIs to evaluate DAVFs.</p></div>","PeriodicalId":33533,"journal":{"name":"Journal of Interventional Medicine","volume":"5 4","pages":"Pages 173-179"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b5/a6/main.PMC9751222.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10460770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.1016/j.jimed.2022.09.001
Chaoyang Wang , Jinghong Yao , Huanzhang Niu , Chongtu Yang , Jiacheng Liu , Yaowei Bai , Shuguang Ju , Bin Xiong
Purpose
To evaluate the dynamic changes in liver function after transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with cirrhosis and to explore its association with clinical outcomes.
Methods
This retrospective study included patients who underwent TIPS between August 2016 and December 2020. Liver function was primarily evaluated using the model for end-stage liver disease (MELD) score, which was analyzed at baseline, 1 week, 1 month, 3 months, 6 months, and 12 months using one-way repeated measures ANOVA. The Kaplan-Meier method, log-rank test, and multivariate analysis were used as appropriate.
Results
In total, 235 patients were included in this study. The MELD score was significantly higher at 1 week (11.8 ± 3.1 vs 13.5 ± 3.5, p < 0.05) and 1 month (11.8 ± 3.1 vs 13.2 ± 4.6, p < 0.05) than the baseline level and recovered at 3 months (11.8 ± 3.1 vs 11.9 ± 3.9, p > 0.05). At 12 months, the MELD score was higher than the baseline level (11.8 ± 3.1 vs 12.4 ± 3.2, p < 0.05). Patients with a recovery of the MELD score (n = 151) at 3 months had a lower probability of overt and severe HE (log-rank p = 0.015 and p = 0.027, respectively) than those without recovery (n = 84). Logistic regression analysis revealed that albumin (odds ratio [OR], 0.926; 95% confidence interval [CI], 0.863–0.992; p = 0.029) and platelet count (OR, 0.993; 95% CI, 0.987–0.999; p = 0.033) were independent predictive factors for non-recovery of the MELD score at 3 months.
Conclusions
Liver function after TIPS creation showed a trend of deterioration at first, followed by recovery. Recovery of liver function at three months was associated with reduced overt and severe HE.
目的评价肝硬化患者经颈静脉肝内门体分流术(TIPS)后肝功能的动态变化,并探讨其与临床预后的关系。方法本回顾性研究纳入了2016年8月至2020年12月期间接受TIPS治疗的患者。使用终末期肝病(MELD)评分模型主要评估肝功能,并在基线、1周、1个月、3个月、6个月和12个月使用单向重复测量方差分析进行分析。酌情采用Kaplan-Meier法、log-rank检验和多变量分析。结果本研究共纳入235例患者。MELD评分在1周时显著升高(11.8±3.1 vs 13.5±3.5,p <0.05)和1个月(11.8±3.1 vs 13.2±4.6,p & lt;0.05), 3个月恢复(11.8±3.1 vs 11.9±3.9,p >0.05)。12个月时,MELD评分高于基线水平(11.8±3.1 vs 12.4±3.2,p <0.05)。3个月MELD评分恢复的患者(n = 151)发生明显和严重HE的概率(log-rank分别为p = 0.015和p = 0.027)低于未恢复的患者(n = 84)。Logistic回归分析显示,白蛋白(比值比[OR], 0.926;95%置信区间[CI], 0.863-0.992;p = 0.029)和血小板计数(OR, 0.993;95% ci, 0.987-0.999;p = 0.033)是3个月MELD评分未恢复的独立预测因素。结论TIPS术后银功能呈先恶化后恢复的趋势。3个月时肝功能恢复与明显和严重HE减少相关。
{"title":"Dynamic changes in liver function after transjugular intrahepatic portosystemic shunt in patients with cirrhosis","authors":"Chaoyang Wang , Jinghong Yao , Huanzhang Niu , Chongtu Yang , Jiacheng Liu , Yaowei Bai , Shuguang Ju , Bin Xiong","doi":"10.1016/j.jimed.2022.09.001","DOIUrl":"10.1016/j.jimed.2022.09.001","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate the dynamic changes in liver function after transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with cirrhosis and to explore its association with clinical outcomes.</p></div><div><h3>Methods</h3><p>This retrospective study included patients who underwent TIPS between August 2016 and December 2020. Liver function was primarily evaluated using the model for end-stage liver disease (MELD) score, which was analyzed at baseline, 1 week, 1 month, 3 months, 6 months, and 12 months using one-way repeated measures ANOVA. The Kaplan-Meier method, log-rank test, and multivariate analysis were used as appropriate.</p></div><div><h3>Results</h3><p>In total, 235 patients were included in this study. The MELD score was significantly higher at 1 week (11.8 ± 3.1 vs 13.5 ± 3.5, p < 0.05) and 1 month (11.8 ± 3.1 vs 13.2 ± 4.6, p < 0.05) than the baseline level and recovered at 3 months (11.8 ± 3.1 vs 11.9 ± 3.9, p > 0.05). At 12 months, the MELD score was higher than the baseline level (11.8 ± 3.1 vs 12.4 ± 3.2, p < 0.05). Patients with a recovery of the MELD score (n = 151) at 3 months had a lower probability of overt and severe HE (log-rank p = 0.015 and p = 0.027, respectively) than those without recovery (n = 84). Logistic regression analysis revealed that albumin (odds ratio [OR], 0.926; 95% confidence interval [CI], 0.863–0.992; p = 0.029) and platelet count (OR, 0.993; 95% CI, 0.987–0.999; p = 0.033) were independent predictive factors for non-recovery of the MELD score at 3 months.</p></div><div><h3>Conclusions</h3><p>Liver function after TIPS creation showed a trend of deterioration at first, followed by recovery. Recovery of liver function at three months was associated with reduced overt and severe HE.</p></div>","PeriodicalId":33533,"journal":{"name":"Journal of Interventional Medicine","volume":"5 4","pages":"Pages 207-212"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1b/c9/main.PMC9751219.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10749784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.1016/j.jimed.2022.09.002
Hai Li , Naijian Ge, Chengjian He, Xiangdong Wang, Wei Xu, Jian Huang, Yefa Yang
Percutaneous transhepatic biliary drainage (PTBD) is an effective treatment for benign and malignant obstructive jaundice. Major bleeding complications occur in approximately 2–3% of patients after PTBD, which can result in death. A case involving a 63-year-old male with malignant obstructive jaundice, who experienced severe bleeding after PTBD, is reported. Emergency digital subtraction angiography, celiac trunk artery and superior mesenteric artery angiography were performed; however, no signs of arterial bleeding were found. To identify etiology, portal venography was performed under ultrasound guidance and portal vein bleeding was diagnosed. Ultimately, selective portal vein embolization successfully stopped the bleeding.
{"title":"Portal vein embolization in the treatment of portal vein bleeding after percutaneous transhepatic biliary drainage: A case report and literature review","authors":"Hai Li , Naijian Ge, Chengjian He, Xiangdong Wang, Wei Xu, Jian Huang, Yefa Yang","doi":"10.1016/j.jimed.2022.09.002","DOIUrl":"10.1016/j.jimed.2022.09.002","url":null,"abstract":"<div><p>Percutaneous transhepatic biliary drainage (PTBD) is an effective treatment for benign and malignant obstructive jaundice. Major bleeding complications occur in approximately 2–3% of patients after PTBD, which can result in death. A case involving a 63-year-old male with malignant obstructive jaundice, who experienced severe bleeding after PTBD, is reported. Emergency digital subtraction angiography, celiac trunk artery and superior mesenteric artery angiography were performed; however, no signs of arterial bleeding were found. To identify etiology, portal venography was performed under ultrasound guidance and portal vein bleeding was diagnosed. Ultimately, selective portal vein embolization successfully stopped the bleeding.</p></div>","PeriodicalId":33533,"journal":{"name":"Journal of Interventional Medicine","volume":"5 4","pages":"Pages 217-220"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d2/c3/main.PMC9751213.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10750254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.1016/j.jimed.2022.03.008
Xishan Li , Guodong Chen , Dongliang Zhu
Background
To evaluate the safety and efficacy of percutaneous transcatheter super-selective renal arterial embolization (SRAE) with N-butyl cyanoacrylate (NBCA) for iatrogenic renal hemorrhage.
Methods
Between January 2014 and December 2019, 45 patients (including 18 patients with coagulopathy), who underwent percutaneous transcatheter SRAE with NBCA for iatrogenic renal hemorrhage at our institution, were retrospectively reviewed. The technical success rate, clinical success rate, and embolization-related complications were analyzed. The values of estimated glomerular filtration rate (eGFR), serum creatinine (sCr), and serum urea (sUr) were analyzed at the time of pre-SRAE, post-SRAE, and last follow-up to evaluate the effects of NBCA-based SRAE on renal function.
Results
Diagnostic renal arteriography revealed contrast extravasation in 18 patients and pseudoaneurysms in 27 patients. NBCA mixed with iodized oil in a 1:2–1:4 ratio was the sole embolic agent. No procedure-related mortality or major complications occurred. The technical and clinical success rates were both 100%. The values of eGFR, sCr and sUr were not found to be significantly different between pre-SRAE, post-SRAE and last follow-up (eGFR: 91.52 ± 21.17 vs. 90.98 ± 22.11 vs. 92.14 ± 23.51 mL/min/1.73 m2, p = 0.729; sCr: 74.73 ± 11.08 vs. 75.27 ± 12.43 vs. 73.95 ± 10.14 μmol/L, p = 0.543; sUr: 5.69 ± 0.84 vs. 5.71 ± 0.96 vs. 5.70 ± 0.79, p = 0.515, respectively).
Conclusions
Percutaneous transcatheter SRAE with NBCA is a safe and effective treatment modality for iatrogenic renal hemorrhage with no deterioration of renal function.
背景:评价经皮经导管超选择性肾动脉栓塞(SRAE)加氰丙烯酸正丁酯(NBCA)治疗医源性肾出血的安全性和有效性。方法回顾性分析我院2014年1月至2019年12月因医源性肾出血行经皮经导管SRAE联合NBCA治疗的45例患者(包括18例凝血功能障碍患者)。分析技术成功率、临床成功率及栓塞相关并发症。分析SRAE术前、术后及末次随访时肾小球滤过率(eGFR)、血清肌酐(sCr)、血清尿素(sUr)的测定值,评价基于nbca的SRAE对肾功能的影响。结果肾动脉造影显示造影剂外渗18例,假性动脉瘤27例。NBCA与碘化油按1:2-1:4的比例混合是唯一的栓塞剂。无手术相关死亡或主要并发症发生。技术和临床成功率均为100%。eGFR、sCr、sUr值在srae前、srae后及末次随访间无显著差异(eGFR: 91.52±21.17 vs 90.98±22.11 vs 92.14±23.51 mL/min/1.73 m2, p = 0.729;可控硅:74.73±11.08和75.27±12.43和73.95±10.14μmol / L, p = 0.543;苏尔:5.69±0.84和5.71±0.96和5.70±0.79,p = 0.515)。结论经皮经导管SRAE联合NBCA治疗医源性肾出血安全有效,且无肾功能恶化。
{"title":"Percutaneous transcatheter super-selective renal arterial embolization with N-butyl cyanoacrylate for iatrogenic renal hemorrhage","authors":"Xishan Li , Guodong Chen , Dongliang Zhu","doi":"10.1016/j.jimed.2022.03.008","DOIUrl":"10.1016/j.jimed.2022.03.008","url":null,"abstract":"<div><h3>Background</h3><p>To evaluate the safety and efficacy of percutaneous transcatheter super-selective renal arterial embolization (SRAE) with N-butyl cyanoacrylate (NBCA) for iatrogenic renal hemorrhage.</p></div><div><h3>Methods</h3><p>Between January 2014 and December 2019, 45 patients (including 18 patients with coagulopathy), who underwent percutaneous transcatheter SRAE with NBCA for iatrogenic renal hemorrhage at our institution, were retrospectively reviewed. The technical success rate, clinical success rate, and embolization-related complications were analyzed. The values of estimated glomerular filtration rate (eGFR), serum creatinine (sCr), and serum urea (sUr) were analyzed at the time of pre-SRAE, post-SRAE, and last follow-up to evaluate the effects of NBCA-based SRAE on renal function.</p></div><div><h3>Results</h3><p>Diagnostic renal arteriography revealed contrast extravasation in 18 patients and pseudoaneurysms in 27 patients. NBCA mixed with iodized oil in a 1:2–1:4 ratio was the sole embolic agent. No procedure-related mortality or major complications occurred. The technical and clinical success rates were both 100%. The values of eGFR, sCr and sUr were not found to be significantly different between pre-SRAE, post-SRAE and last follow-up (eGFR: 91.52 ± 21.17 vs. 90.98 ± 22.11 vs. 92.14 ± 23.51 mL/min/1.73 m<sup>2</sup>, <em>p</em> = 0.729; sCr: 74.73 ± 11.08 vs. 75.27 ± 12.43 vs. 73.95 ± 10.14 μmol/L, <em>p</em> = 0.543; sUr: 5.69 ± 0.84 vs. 5.71 ± 0.96 vs. 5.70 ± 0.79, <em>p</em> = 0.515, respectively).</p></div><div><h3>Conclusions</h3><p>Percutaneous transcatheter SRAE with NBCA is a safe and effective treatment modality for iatrogenic renal hemorrhage with no deterioration of renal function.</p></div>","PeriodicalId":33533,"journal":{"name":"Journal of Interventional Medicine","volume":"5 4","pages":"Pages 200-206"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7a/d3/main.PMC9751212.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10749785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}