Pub Date : 2026-01-01DOI: 10.1016/j.jvir.2025.09.016
Aren B. Mnatzakanian MD , Bronwyn L. Schemmer BHSc , Neil J. Resnick MD , Karim Virani MD, MSc
{"title":"Lessons in IR: Management of Radial Artery Pseudoaneurysm with Extended Hemostatic Band Compression","authors":"Aren B. Mnatzakanian MD , Bronwyn L. Schemmer BHSc , Neil J. Resnick MD , Karim Virani MD, MSc","doi":"10.1016/j.jvir.2025.09.016","DOIUrl":"10.1016/j.jvir.2025.09.016","url":null,"abstract":"","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":"37 1","pages":"Article 107844"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jvir.2025.08.042
Edward J. Walsh MD , Hasnain Bawaadam MD, MPH , Joseph G. Mammarappallil MD, PhD , Jason R. Snider MD , William C. Allsopp DO , Frederick J. Brodeur MD , Aaron R. Green MD , Ganesh Krishna MD , Brandon M. Wojcik MD
Thoracic surgeons using minimally invasive techniques for lung nodule resection often rely on localization markers to determine precise nodule location intraoperatively. Transbronchial or transthoracic injection of indocyanine green (ICG) dye has become a popular technique. However, surgery must be performed immediately before dye dissipates into surrounding tissue. This multicenter retrospective study evaluated the effectiveness of computed tomography (CT)–guided transthoracic placement of ICG dye–soaked coils (ICG-Cs) for preoperative lung nodule localization. Nineteen adult patients with 21 nodules underwent CT ICG-C placement from March 01, 2023, until February 28, 2025, at 2 medical centers. There were no adverse events. Median time from localization to surgery was 1 day (interquartile range, 0–4 days), with 57.1% undergoing surgery >24 hours later. Localization success rate was 100%. CT-guided transthoracic placement of ICG-C is a novel technique that allows for accurate nodule localization, delayed surgical resection, and the preservation of healthy lung tissue.
{"title":"Lung Tumors Marked Percutaneously with Indocyanine Green Dye–Soaked Embolization Coils: A Visual Beacon for Accurate Intraoperative Localization during Lung-Sparing Surgery","authors":"Edward J. Walsh MD , Hasnain Bawaadam MD, MPH , Joseph G. Mammarappallil MD, PhD , Jason R. Snider MD , William C. Allsopp DO , Frederick J. Brodeur MD , Aaron R. Green MD , Ganesh Krishna MD , Brandon M. Wojcik MD","doi":"10.1016/j.jvir.2025.08.042","DOIUrl":"10.1016/j.jvir.2025.08.042","url":null,"abstract":"<div><div>Thoracic surgeons using minimally invasive techniques for lung nodule resection often rely on localization markers to determine precise nodule location intraoperatively. Transbronchial or transthoracic injection of indocyanine green (ICG) dye has become a popular technique. However, surgery must be performed immediately before dye dissipates into surrounding tissue. This multicenter retrospective study evaluated the effectiveness of computed tomography (CT)–guided transthoracic placement of ICG dye–soaked coils (ICG-Cs) for preoperative lung nodule localization. Nineteen adult patients with 21 nodules underwent CT ICG-C placement from March 01, 2023, until February 28, 2025, at 2 medical centers. There were no adverse events. Median time from localization to surgery was 1 day (interquartile range, 0–4 days), with 57.1% undergoing surgery >24 hours later. Localization success rate was 100%. CT-guided transthoracic placement of ICG-C is a novel technique that allows for accurate nodule localization, delayed surgical resection, and the preservation of healthy lung tissue.</div></div>","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":"37 1","pages":"Article 107825"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jvir.2025.09.038
Eunbyeol Ko BS, Jin Hyoung Kim MD, Jihoon Kim MD, Gun Ha Kim MD, Heung-Kyu Ko MD, Hee Ho Chu MD, Ji Hoon Shin MD, Dong Il Gwon MD, Byung Soo Im MD, Gi-Young Ko MD
Purpose
To evaluate the safety and effectiveness of transarterial chemoembolization (TACE) as first-line treatment for single caudate lobe hepatocellular carcinoma (HCC).
Materials and Methods
A total of 107 treatment-naive patients who received TACE between 2006 and 2023 as first-line treatment for single caudate lobe HCC were retrospectively evaluated. Adverse events, radiologic tumor response, progression-free survival (PFS), and overall survival (OS) following TACE were investigated. Periprocedural variables related to complete response (CR) and OS were investigated using multivariable regression analyses.
Results
Complete TACE (cisplatin, ethiodized oil, and gelatin foam particles) through all tumor-feeding caudate arteries was possible in 73% of the study patients. The severe adverse event rate was 2.8%. A CR at 1 month after TACE was achieved in 67% of the study patients, and multivariable analysis showed that complete TACE (P < .001; odds ratio [OR], 42.86) and a single tumor-feeding artery (P = .002; OR, 8.04) were significant predictors of a CR. The median PFS after TACE was 29 months. After TACE, the 3-, 5-, and 10-year OS rates were 62%, 46%, and 33%, respectively, and the median OS was 53 months. Multivariable analysis revealed 4 significant periprocedural risk factors: (a) incomplete TACE (P = .004; hazard ratio [HR], 2.69), (b) multiple tumor-feeding arteries (P = .04; HR, 2.02), (c) Child-Pugh Class B (P = .003; HR, 2.91), and (d) advanced-stage HCC (P = .02; HR, 3.43).
Conclusions
TACE appears to be a safe and potentially effective first-line treatment option, with long PFS, for patients with single HCC located in the caudate lobe.
{"title":"Safety and Effectiveness of Transarterial Chemoembolization for Caudate Lobe Hepatocellular Carcinoma: Long-Term Clinical Outcomes","authors":"Eunbyeol Ko BS, Jin Hyoung Kim MD, Jihoon Kim MD, Gun Ha Kim MD, Heung-Kyu Ko MD, Hee Ho Chu MD, Ji Hoon Shin MD, Dong Il Gwon MD, Byung Soo Im MD, Gi-Young Ko MD","doi":"10.1016/j.jvir.2025.09.038","DOIUrl":"10.1016/j.jvir.2025.09.038","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the safety and effectiveness of transarterial chemoembolization (TACE) as first-line treatment for single caudate lobe hepatocellular carcinoma (HCC).</div></div><div><h3>Materials and Methods</h3><div>A total of 107 treatment-naive patients who received TACE between 2006 and 2023 as first-line treatment for single caudate lobe HCC were retrospectively evaluated. Adverse events, radiologic tumor response, progression-free survival (PFS), and overall survival (OS) following TACE were investigated. Periprocedural variables related to complete response (CR) and OS were investigated using multivariable regression analyses.</div></div><div><h3>Results</h3><div>Complete TACE (cisplatin, ethiodized oil, and gelatin foam particles) through all tumor-feeding caudate arteries was possible in 73% of the study patients. The severe adverse event rate was 2.8%. A CR at 1 month after TACE was achieved in 67% of the study patients, and multivariable analysis showed that complete TACE (<em>P</em> < .001; odds ratio [OR], 42.86) and a single tumor-feeding artery (<em>P</em> = .002; OR, 8.04) were significant predictors of a CR. The median PFS after TACE was 29 months. After TACE, the 3-, 5-, and 10-year OS rates were 62%, 46%, and 33%, respectively, and the median OS was 53 months. Multivariable analysis revealed 4 significant periprocedural risk factors: (<em>a</em>) incomplete TACE (<em>P</em> = .004; hazard ratio [HR], 2.69), (<em>b</em>) multiple tumor-feeding arteries (<em>P</em> = .04; HR, 2.02), (<em>c</em>) Child-Pugh Class B (<em>P</em> = .003; HR, 2.91), and (<em>d</em>) advanced-stage HCC (<em>P</em> = .02; HR, 3.43).</div></div><div><h3>Conclusions</h3><div>TACE appears to be a safe and potentially effective first-line treatment option, with long PFS, for patients with single HCC located in the caudate lobe.</div></div>","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":"37 1","pages":"Article 107867"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jvir.2025.09.039
Nikiforos Vasiniotis Kamarinos MD , Peter J. Littrup MD , Constantinos T. Sofocleous MD, PhD , Stephen B. Solomon MD , Robert C. Ward MD
Breast cryoablation is a minimally invasive procedure that has demonstrated feasibility, tolerability, and effectiveness in eradicating small breast cancers. The integration of multimodal imaging systems is crucial for optimal patient selection, precise tumor targeting, and complete tumor eradication. Expanding the use of cryoablation to larger tumors may be feasible by leveraging established ablation techniques, such as ablation margin confirmation and postablation biopsy.
{"title":"Strategies to Optimize Success in Breast Cancer Cryoablation","authors":"Nikiforos Vasiniotis Kamarinos MD , Peter J. Littrup MD , Constantinos T. Sofocleous MD, PhD , Stephen B. Solomon MD , Robert C. Ward MD","doi":"10.1016/j.jvir.2025.09.039","DOIUrl":"10.1016/j.jvir.2025.09.039","url":null,"abstract":"<div><div>Breast cryoablation is a minimally invasive procedure that has demonstrated feasibility, tolerability, and effectiveness in eradicating small breast cancers. The integration of multimodal imaging systems is crucial for optimal patient selection, precise tumor targeting, and complete tumor eradication. Expanding the use of cryoablation to larger tumors may be feasible by leveraging established ablation techniques, such as ablation margin confirmation and postablation biopsy.</div></div>","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":"37 1","pages":"Article 107872"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jvir.2025.10.005
Deborah Rabinowitz MD , Gabriele Meyer DO , J. Fernando Del Rosario MD , Maxim Itkin MD
{"title":"Protein-Losing Enterofpathy Treated by Endoscopic Embolization of Lymphatic Leakage in the Duodenum","authors":"Deborah Rabinowitz MD , Gabriele Meyer DO , J. Fernando Del Rosario MD , Maxim Itkin MD","doi":"10.1016/j.jvir.2025.10.005","DOIUrl":"10.1016/j.jvir.2025.10.005","url":null,"abstract":"","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":"37 1","pages":"Article 107873"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Aliya as High-Frequency Irreversible Electroporation: A Call for Consistent Pulsed Electric Field Terminology in IR Literature","authors":"Hamidreza Rouientan MD , Mohammad Ghasemi-Rad MD , Shahram Akhlaghpoor MD","doi":"10.1016/j.jvir.2025.107988","DOIUrl":"10.1016/j.jvir.2025.107988","url":null,"abstract":"","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":"37 4","pages":"Article 107988"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jvir.2025.09.006
M.Allan Thomas PhD , Tharun Alamuri BS , Ryan C. Lee BS , Dan Giardina MD , John Karageorgiou MD , Naganathan Mani MD , Daniel A. Braga MD , Christopher D. Malone MD
Purpose
To test the hypothesis that lung shunt fraction (LSF) in yttrium-90 (90Y) radioembolization (RE) of the liver can be modeled for clinical relevance and risk on the basis of cancer type, tumor size, and imaging modality.
Materials and Methods
This was a retrospective analysis of 354 consecutive cases from a 34-month period at a single institution. Cancer type (hepatocellular carcinoma [HCC] vs non-HCC) and maximum tumor size were tracked. LSF was computed from planar imaging (LSFplanar) and 3 macroaggregated albumin–single photon emission computed tomography (SPECT)/computed tomography (CT) methods with different corrections at the lung/liver boundary (LSFFull, LSF2cm, and LSFLeft). Five tumor categories were analyzed: (a) HCC measuring <3 cm, (b) HCC measuring 3–8 cm, (c) HCC measuring >8 cm, (d) cases with transjugular intrahepatic portosystemic shunt (TIPS)/vascular invasion, and (e) non-HCC.
Results
Median LSF was significantly different (all P < .001) among LSFplanar, LSFFull, LSF2cm, and LSFLeft methods, with values of 6.9%, 3.9%, 1.4%, and 0.8%, respectively. There were 72% and 19% of cases with LSFplanar of >5% and >10%, respectively, but only 7% and 2% using LSF2cm. LSF was lower for HCC measuring <3 cm relative to HCC measuring 3–8 cm and >8 cm (P ≤ .003). In the <3-cm HCC group, there were no cases with LSFplanar > 20% or LSF2cm > 5%. Cases with TIPS/vascular invasion maintained the highest median LSF (LSFplanar, 9.0%; LSF2cm, 2.8%) and the highest percentages of cases with LSF values of >10% and >20% across all methods.
Conclusions
Despite significant variations with imaging modality and correction methods, consistent trends in LSF magnitude with cancer type and tumor size were still uncovered. The relative risk of observing clinically relevant LSF can be modeled for different liver tumor categories in 90Y-RE.
{"title":"Modeling Clinical Relevance and Risk in Yttrium-90 Radioembolization of the Liver: Lung Shunt Fraction Variability According to Imaging Modality, Cancer Type, and Tumor Size","authors":"M.Allan Thomas PhD , Tharun Alamuri BS , Ryan C. Lee BS , Dan Giardina MD , John Karageorgiou MD , Naganathan Mani MD , Daniel A. Braga MD , Christopher D. Malone MD","doi":"10.1016/j.jvir.2025.09.006","DOIUrl":"10.1016/j.jvir.2025.09.006","url":null,"abstract":"<div><h3>Purpose</h3><div>To test the hypothesis that lung shunt fraction (LSF) in yttrium-90 (<sup>90</sup>Y) radioembolization (RE) of the liver can be modeled for clinical relevance and risk on the basis of cancer type, tumor size, and imaging modality.</div></div><div><h3>Materials and Methods</h3><div>This was a retrospective analysis of 354 consecutive cases from a 34-month period at a single institution. Cancer type (hepatocellular carcinoma [HCC] vs non-HCC) and maximum tumor size were tracked. LSF was computed from planar imaging (LSF<sub>planar</sub>) and 3 macroaggregated albumin–single photon emission computed tomography (SPECT)/computed tomography (CT) methods with different corrections at the lung/liver boundary (LSF<sub>Full</sub>, LSF<sub>2cm</sub>, and LSF<sub>Left</sub>). Five tumor categories were analyzed: (<em>a</em>) HCC measuring <3 cm, (<em>b</em>) HCC measuring 3–8 cm, (<em>c</em>) HCC measuring >8 cm, (<em>d</em>) cases with transjugular intrahepatic portosystemic shunt (TIPS)/vascular invasion, and (<em>e</em>) non-HCC.</div></div><div><h3>Results</h3><div>Median LSF was significantly different (all <em>P</em> < .001) among LSF<sub>planar</sub>, LSF<sub>Full</sub>, LSF<sub>2cm</sub>, and LSF<sub>Left</sub> methods, with values of 6.9%, 3.9%, 1.4%, and 0.8%, respectively. There were 72% and 19% of cases with LSF<sub>planar</sub> of >5% and >10%, respectively, but only 7% and 2% using LSF<sub>2cm</sub>. LSF was lower for HCC measuring <3 cm relative to HCC measuring 3–8 cm and >8 cm (<em>P</em> ≤ .003). In the <3-cm HCC group, there were no cases with LSF<sub>planar</sub> > 20% or LSF<sub>2cm</sub> > 5%. Cases with TIPS/vascular invasion maintained the highest median LSF (LSF<sub>planar</sub>, 9.0%; LSF<sub>2cm</sub>, 2.8%) and the highest percentages of cases with LSF values of >10% and >20% across all methods.</div></div><div><h3>Conclusions</h3><div>Despite significant variations with imaging modality and correction methods, consistent trends in LSF magnitude with cancer type and tumor size were still uncovered. The relative risk of observing clinically relevant LSF can be modeled for different liver tumor categories in <sup>90</sup>Y-RE.</div></div>","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":"37 1","pages":"Article 107834"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jvir.2025.09.037
Carin F. Gonsalves MD , Stefan Stortecky MD, MPH , Samuel Horr MD , Orestis Pappas MD , Ripal T. Gandhi MD , Keith Pereira MD , Jay Giri MD, MPH , Sameer J. Khandhar MD , Ezana M. Azene MD, PhD , Fakhir Elmasri MD , Jonathan Lindquist MD , Wissam A. Jaber MD
Purpose
To assess whether catheter-directed thrombolysis (CDT) treatment heterogeneity in the multicenter PEERLESS randomized controlled trial is associated with differences in pulmonary embolism (PE) clinical outcomes.
Materials and Methods
All PEERLESS CDT arm patients were eligible for post hoc analysis, excluding those treated with multiple CDT device types (n = 8), non–tissue plasminogen activator (tPA) thrombolytics (n = 10), or pharmacomechanical CDT (n = 12). Patients were grouped by treatment: ultrasound (US)–assisted thrombolysis or standard CDT (SCDT). Treatment protocols were assessed, and clinical, safety, and quality-of-life outcomes were compared at discharge/7 days, 24 hours, and/or 30 days.
Results
A total of 159 patients treated with US-accelerated CDT and 87 treated with SCDT were included. Longer mean treatment duration (12.4 hours vs 20.8 hours, P < .001), higher mean thrombolytic dose (17.2-mg tPA vs 23.4-mg tPA, P < .001), and more intensive care unit stays >24 hours (57.4% vs 80.5%, P < .001) were identified in the SCDT group. However, in-hospital outcomes were not different, including all-cause mortality (0.0% vs 1.1%, P = .35), intracranial hemorrhage (0.6% vs 0.0%, P = 1.00), major bleeding (5.7% vs 10.3%, P = .20), and clinical deterioration and/or bailout (5.0% vs 5.7%, P = .77). Right ventricular/left ventricular ratio reduction (19.9% vs 23.1%, P = .10) and respirations per minute (20.0 vs 19.9, P = .62) were not statistically significantly different at the 24-hour visit. Pulmonary Embolism Quality of Life (18.5 vs 23.0, P = .18) and EuroQol 5-Dimension 5-Level (0.84 vs 0.81, P = .85) were also not different at the 30-day visit.
Conclusions
Treatment duration and tPA dose were significantly lower in patients treated with US-accelerated CDT; however, clinical outcomes did not differ significantly between US-accelerated CDT and SCDT. This suggests that the primary analysis of PEERLESS may be generalizable to tPA-based CDT treatment protocols currently in use.
目的：评估多中心[已编辑]随机对照试验中导管定向溶栓（CDT）治疗的异质性是否与肺栓塞（PE）临床结果的差异相关。材料和方法：所有CDT组患者均符合事后分析的条件，不包括使用多种CDT装置（n=8）、非tpa溶栓药物（n=10）或药物力学CDT （n=12）治疗的患者。患者按治疗方式分组：超声加速CDT （USAT）或标准CDT （SCDT）。对治疗方案进行评估，并在出院/7天、24小时和/或30天比较临床、安全性和生活质量结果。结果：纳入159例USAT和87例SCDT患者。更长平均治疗时间（12.4 vs 20.8小时，p24小时）（57.4% vs 80.5%）结论：USAT治疗患者的治疗时间和tPA剂量显著降低，但USAT和SCDT之间的临床结果无显著差异。这表明[已编辑]的初步分析可以推广到目前使用的基于tpa的CDT治疗方案。
{"title":"Evaluation of Catheter-Directed Thrombolysis Device Type and Dosing on Treatment Outcomes in Intermediate-Risk Pulmonary Embolism: A PEERLESS Randomized Controlled Trial Post Hoc Analysis","authors":"Carin F. Gonsalves MD , Stefan Stortecky MD, MPH , Samuel Horr MD , Orestis Pappas MD , Ripal T. Gandhi MD , Keith Pereira MD , Jay Giri MD, MPH , Sameer J. Khandhar MD , Ezana M. Azene MD, PhD , Fakhir Elmasri MD , Jonathan Lindquist MD , Wissam A. Jaber MD","doi":"10.1016/j.jvir.2025.09.037","DOIUrl":"10.1016/j.jvir.2025.09.037","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess whether catheter-directed thrombolysis (CDT) treatment heterogeneity in the multicenter PEERLESS randomized controlled trial is associated with differences in pulmonary embolism (PE) clinical outcomes.</div></div><div><h3>Materials and Methods</h3><div>All PEERLESS CDT arm patients were eligible for post hoc analysis, excluding those treated with multiple CDT device types (n = 8), non–tissue plasminogen activator (tPA) thrombolytics (n = 10), or pharmacomechanical CDT (n = 12). Patients were grouped by treatment: ultrasound (US)–assisted thrombolysis or standard CDT (SCDT). Treatment protocols were assessed, and clinical, safety, and quality-of-life outcomes were compared at discharge/7 days, 24 hours, and/or 30 days.</div></div><div><h3>Results</h3><div>A total of 159 patients treated with US-accelerated CDT and 87 treated with SCDT were included. Longer mean treatment duration (12.4 hours vs 20.8 hours, <em>P</em> < .001), higher mean thrombolytic dose (17.2-mg tPA vs 23.4-mg tPA, <em>P</em> < .001), and more intensive care unit stays >24 hours (57.4% vs 80.5%, <em>P</em> < .001) were identified in the SCDT group. However, in-hospital outcomes were not different, including all-cause mortality (0.0% vs 1.1%, <em>P</em> = .35), intracranial hemorrhage (0.6% vs 0.0%, <em>P</em> = 1.00), major bleeding (5.7% vs 10.3%, <em>P</em> = .20), and clinical deterioration and/or bailout (5.0% vs 5.7%, <em>P</em> = .77). Right ventricular/left ventricular ratio reduction (19.9% vs 23.1%, <em>P</em> = .10) and respirations per minute (20.0 vs 19.9, <em>P</em> = .62) were not statistically significantly different at the 24-hour visit. Pulmonary Embolism Quality of Life (18.5 vs 23.0, <em>P</em> = .18) and EuroQol 5-Dimension 5-Level (0.84 vs 0.81, <em>P</em> = .85) were also not different at the 30-day visit.</div></div><div><h3>Conclusions</h3><div>Treatment duration and tPA dose were significantly lower in patients treated with US-accelerated CDT; however, clinical outcomes did not differ significantly between US-accelerated CDT and SCDT. This suggests that the primary analysis of PEERLESS may be generalizable to tPA-based CDT treatment protocols currently in use.</div></div>","PeriodicalId":49962,"journal":{"name":"Journal of Vascular and Interventional Radiology","volume":"37 1","pages":"Article 107866"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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