Journal of Vascular and Interventional Radiology最新文献

Purpose: To investigate whether transarterial embolization (TAE) and systemic gemcitabine + cisplatin (GC) modulates CD4⁺CD25⁺Foxp3⁺ regulatory T cells (Tregs) infiltration, a major immunosuppressive subset, and expression of vascular endothelial growth factor (VEGF), a critical pro-angiogenic molecule, in a thioacetamide-induced orthotopic intrahepatic cholangiocarcinoma (ICC) model using male Sprague-Dawley (SD) rats.

Materials and methods: 24 ICC-bearing SD rats were randomized into 4 groups (n=6 per group). The control group received no treatment while the G+C group was given intraperitoneal injections of gemcitabine (200 mg/kg) plus cisplatin (8 mg/kg) on Days 0, 4, 8 and 12. The TAE group underwent hepatic artery embolization on Day 0 and the combination group received TAE on Day 0 followed by GC administration. Tumor volume was measured via CT on Days -1,7,14. Flow cytometry determined the proportion of Tregs among CD4⁺ T cells. Intratumoral Treg density is quantified by immunofluorescence. Immunohistochemistry detected VEGF expression. Statistical analysis used one-way ANOVA with appropriate post hoc tests.

Results: No significant tumor volume differences within 14 days. TAE increased peripheral Treg proportion while GC and combination therapy reduced it. The combination group had the lowest intratumoral Treg proportion (5.25%±0.76%). VEGF expression was elevated in the TAE group but suppressed in the combination group (8.68%±1.36% vs. control 18.37%±3.24%, P = 0.0140) . All treatment groups showed reduced intratumoral Treg density compared with the control.

Conclusion: In a thioacetamide-induced orthotopic ICC rat model, TAE combined with systemic GC reduces intratumoral Treg infiltration and VEGF expression. These findings indicate the combination therapy exerts superior immunomodulatory effects compared with TAE or GC monotherapy in rats.

Purpose: To evaluate the contralateral suppression index (CSI) as a diagnostic tool for predicting aldosterone lateralization under simulated incomplete adrenal vein sampling (AVS), and to assess the impact of adrenal nodules and age on its performance.

Materials and methods: We retrospectively reviewed consecutive patients who underwent AVS for primary aldosteronism between January 1, 2016, and June 30, 2024. A total of 362 patients were analyzed. Bilaterally selective studies were reanalyzed by masking one adrenal side to simulate incomplete sampling. CSI was calculated from the available adrenal vein and inferior vena cava samples and tested across three thresholds (>1.0, >0.5 and >0.2) using lateralization index (LI) ≥4.0 as the reference. Performance metrics included positive predictive value (PPV), sensitivity, and specificity, overall and stratified by adrenal nodules and age (<35 vs ≥35 years).

Results: Mean CSI was 0.33 in lateralized cases (LI ≥4.0) and 3.16 in non-lateralized cases (p<0.001). Without a concordant nodule, CSI<1 supported lateralization (PPV 70%, sensitivity 88%, specificity 94%); stricter thresholds increased certainty, with CSI<0.5 yielding PPV 98% and specificity 99% (sensitivity 61%) and CSI<0.2 achieving PPV and specificity of 100% (sensitivity 28%). With a concordant nodule, PPVs were 94%, 99%, and 100% at CSI<1, ≤0.5, and ≤0.2, with sensitivity 98-64%. Results were consistent across age groups.

Conclusion: CSI reliably predicted aldosterone lateralization under simulated incomplete AVS. Thresholds ≤0.5 and ≤0.2 provided confirmatory accuracy, particularly when combined with concordant imaging.

Purpose: To provide recommendations for the most appropriate endovascular intervention of femoropopliteal (FP) arterial disease based on plaque characterization.

Material and method: A panel of 22 physicians from multiple disciplines participated in a modified-Delphi consensus, leveraging the RAND/UCLA Appropriateness Method. Panelists engaged in two rounds of voting, following a literature review, with an in-person discussion prior to the second round of voting. A rigorous statistical approach was utilized to analyze the points of agreement and disagreement. Consensus-based recommendations on the most appropriate endovascular approaches for treating patients with FP lesions, stratified by lesion morphology, were generated.

Results: Overall, 490 individual items were included in the voting, 458 (93%) of which achieved consensus and 32 (7%) were non-consensus items, based on a priori criteria under the following categories: (1) recommendations on method for determining plaque morphology; (2) preferred endovascular devices for vessel preparation and definitive treatment stratified by (a) plaque morphology and (b) Tosaka classification of in-stent restenosis; and (3) vessel preparation device safety-related considerations.

Conclusion: This international, multidisciplinary consensus provides evidence- and expert-informed recommendations for vessel preparation and definitive treatment of FP arterial disease, tailored to plaque morphology. These consensus recommendations aim to support clinical decision-making and promote best interventional practices by serving as an expert-opinion supplement to existing guideline-based care pathways.