CVIR Endovascular最新文献

Background: Benign prostatic hyperplasia (BPH) is the most common urological disorder in older males, often treated with prostate artery embolization (PAE) to alleviate lower urinary tract symptoms. While traditional embolic materials like microspheres are common, issues such as symptom recurrence and non-target embolization remain. This systematic review evaluates the safety and effectiveness of n-butyl cyanoacrylate (NBCA) glue as an alternative embolic agent for PAE.

Materials and methods: A thorough search was performed across databases including PubMed, ScienceDirect, Cochrane, Google Scholar, Scopus, and MEDLINE. Studies were included if they assessed NBCA glue for PAE in BPH patients. Exclusions were made for reviews, non-English articles, conference abstracts, and studies not using glue or ethiodized oil mixtures. The Methodological Index for Non-Randomized Studies criteria was used to assess bias risk, and due to varied outcome measures, a narrative synthesis was conducted.

Results: Six studies involving 667 patients met the inclusion criteria. The age in mean ± SD across studies ranged from 67.5 ± 7.8 to 72.6 ± 10.5 with most patients presenting with moderate to severe BPH unresponsive to medication. NBCA glue-based procedures showed high technical success rates and shorter procedure times. International Prostate Symptom Score improvement was reported in 83-94% of patients across all studies with associated quality of life significantly enhanced in up to 94% of patients as well. Prostate volume reduction ranged from 11% to 40.5%, depending on follow-up duration. PSA levels and medication use decreased, and erectile function was mostly preserved, though results varied. Minor complications like groin hematomas and post-embolization syndrome occurred in 4-22% of patients, with no major adverse events reported.

Conclusion: This review assesses NBCA-based glue as a potential embolic agent in PAE for BPH. The evidence suggests promising short-term outcomes with a favorable safety profile, though findings remain preliminary due to small sample sizes and short follow-up. Larger multicenter randomized trials are therefore needed to validate these results and guide clinical practice.

Background: To systematically scope the clinical integration of artificial intelligence (AI) in diagnostic and interventional radiology. This integration encompasses various components of AI forms such as deep learning, convolutional neural networks, natural language processing, and machine learning.

Methodology: A Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) was employed to evaluate current primary and translation literature on the utility of AI in diagnostic and interventional radiology in broad disease categories.

Results: Following the review for inclusion criteria, a total of 23 peer-reviewed research articles were selected for review. Notably, most studies were found to focus on diagnostic and interventional radiology and oncologic diseases, including lung, hepatocellular, colorectal, prostate, pancreatic, breast, and blood cancers.

Conclusions: Radiologists have an advantageous role with the integration of these tools in clinical practice. This may include disease prediction models, catheter navigation, and image reconstruction. Utilization of these AI tools can help improve and further expose of the capabilities of diagnostic and interventional radiology to patients worldwide. From a disease standpoint, this review found most of the clinical literature has implemented AI tools for diagnostic and interventional radiology in oncology, followed by vascular diseases. Careful navigation is necessary to address the current logistical challenges, educational demands, and ethical dilemmas to ensure the safe and effective incorporation of these technologies into clinical radiologic settings.

Purpose: To discuss endovascular techniques and report the outcomes for endovascular treatment of true renal arterial aneurysms (TRAAs).

Materials and methods: A 22-year retrospective analysis of endovascular treatment of TRAAs in our institution. Aneurysm characteristics and endovascular techniques are discussed. Outcome measures were technical and clinical success (need for reintervention), renal parenchymal perfusion loss, impact on renal function, and complications. A 30-day mortality analysis was performed. Impact on renal function was assessed with a two-tailed, paired t-test of pre- and post-procedural serum creatinine.

Results: Eighteen endovascular procedures were performed to treat 15 TRAAs in 14 patients (including three reinterventions). 14/15 TRAAs were classified as Type 2 and 1/15 as Type 1 (Rundback classification). Mean initial aneurysm size was 22.9 mm (range 5-40 mm). Of the 14 Type 2 TRAAs, five were initially treated with balloon-assisted Onyx embolisation, four with stent-assisted coiling, four with sac packing, and one with stent-grafting. The technical success rate was 100%. The TRAAs requiring reintervention had been originally treated with balloon-assisted Onyx embolisation (two TRAAs) and stent-grafting (one TRAA). Renal parenchymal loss was < 10% in 10/15 TRAAs after initial intervention. At reintervention, 2/3 cases had 60-70% estimated parenchymal loss as the TRAAs had to be treated more aggressively. Complications (grade 1-3) occurred in 5/18 procedures. The grade 2 complication was atrophy and loss of renal function of the treated kidney (with serum creatinine remaining in the normal range) (n = 1). Grade 3 complications were brachial access pseudoaneurysm (n = 1), common femoral vein thrombosis (n = 1), and access site cellulitis (n = 1).

Conclusion: Endovascular treatment of TRAAs has a high rate of technical success and a low impact on renal function. A higher rate of reintervention was observed for TRAAs treated with Onyx embolisation, leading to a shift towards stent-assisted coiling as our preferred technique when anatomically feasible.

Background: Drug-coated balloons (DCBs) are widely used in endovascular therapy. While dissection angle and minimum lumen area (MLA) assessed by intravascular ultrasound (IVUS) are known predictors of restenosis, their specific role after DCB angioplasty remains to be fully elucidated. We aimed to identify predictors of restenosis following DCB angioplasty using IVUS findings.

Methods: We retrospectively enrolled 36 peripheral artery disease patients undergoing DCB angioplasty (Jan 2021-Dec 2023). We evaluated IVUS images post-guidewire and post-DCB at 3-cm intervals, classifying cross-sections by MLA/external elastic membrane area (EEMA) ratio: > 50%, 40%-50%, and < 40%. Primary patency at 1 year post-DCB was the primary outcome. Restenosis was objectively determined by a peak systolic velocity ratio of 2.4 on duplex ultrasound, and assessing each cross-sectional images.

Results: A total of 262 cross-sectional images were acquired and subsequently classified into three distinct groups based on their MLA/EEMA ratio: > 50% (n = 125), 40%-50% (n = 85), and < 40% (n = 52). All guidewires passed through the intraplaque route. Primary patency was significantly higher in the MLA/EEMA > 50% group (94.0% vs. 84.2% vs. 73.3%, log-rank p = 0.005). Specifically, for dissection angles > 60°, patency was markedly better in the MLA/EEMA > 50% group (93.3% vs. 75.0% vs. 55.6%, log-rank p = 0.03). Dissection angles < 60° showed no significant patency differences (93.9% vs. 88.0% vs. 84.2%, log-rank p = 0.14).

Conclusions: The MLA/EEMA ratio and the degree of dissection angle may be predictors of primary patency following DCB angioplasty. These findings suggest that optimized vessel preparation strategies can effectively mitigate the adverse clinical impact of dissection.

Background: Tumor visualization during computed tomography (CT)-guided radiofrequency ablation (RFA) of adrenal adenomas is often limited by the small size of the lesion and needle-induced artifacts. These limitations can impair accurate needle placement and increase the risk of incomplete ablation. This report shows four adrenal RFA procedures in which iodized oil (Lipiodol®) marking enhanced lesion visibility.

Case presentation: CT imaging and adrenal venous sampling showed unilateral right aldosterone-producing adenomas measuring 10-20 mm in patients with primary aldosteronism. Contrast enhancement of the nodules was confirmed via CT angiography after microcatheter insertion into the adrenal artery. Transarterial embolization was performed utilizing a 1:1 mixture of Lipiodol and iohexol. In three cases, Lipiodol deposition within the adenomas was confirmed on CT immediately post-embolization and persisted on the following day. Despite needle-induced artifacts during RFA, nodule visibility significantly improved. RFA was completed without major complications, which resulted in the resolution of primary aldosteronism and hypertension. In one case, although Lipiodol marking was discontinued due to the extravasation from the adrenal artery branch, RFA was completed on the following day.

Conclusions: CT-guided RFA with Lipiodol marking facilitated the effective treatment of aldosterone-producing adrenal adenomas in three patients by significantly enhancing lesion visibility. Adrenal arterial embolization should be addressed with caution to avoid damaging the small blood vessels of the adrenal gland.

Background: Central venous access catheter (CVC) devices are a critical part of care in patients with a variety of treatment needs but are not without complications.

Case presentation: A 5-year-old male child with a background of autosomal recessive nephrotic syndrome developed a septic right atrial thrombus related to his dialysis line. Mechanical thrombectomy and line removal was complicated by tract haemorrhage, requiring the integrated management of thrombosis and haemorrhage. Haemostasis was achieved with combination of compression and sealing of the subcutaneous tract.

Conclusion: This case provides an excellent example of tract haemorrhage demonstrated fluoroscopically. We discuss the available treatment options, which may need to be employed in urgent or emergent fashion, in paediatric patients with differing physiological reserves.

Background: Obesity is a global pandemic affecting more than 1 billion people worldwide and a leading cause of preventable death. Left gastric artery embolisation to inhibit ghrelin secretion, a hormonal driver of appetite, has been proposed as a potentially safer treatment for obesity than surgery. This study describes the incidence of anatomical variation, gastric artery anastomoses, collateral supply and vessel lengths, diameters and angles of origin relevant to embolisation of the LGA in the EMBIO cohort of obese patients.

Results: Arterial phase CT scans (n = 90) were performed as part of screening for the EMBIO trial. 62 participants (69%) had conventional coeliac and hepatic artery anatomy. 14 participants (16%) had left hepatic arterial supply originating from the LGA. The most common LGA branching pattern (37%) was for the first branch to supply the cardia / gastro-oesophageal junction and then for the LGA to split into two main branches supplying the gastric fundus. 34% had a left- right gastric artery anastomosis visible on CT. The LGA was the dominant artery supplying the gastric fundus in 51% with supply from multiple arteries, most frequently the LGA and short gastric arteries (27%), seen in the other participants.

Conclusion: This study presents detailed analysis of the arterial anatomy relevant to performing successful and safe embolisation of the LGA for treatment of obesity and acute haemorrhage.

Purpose: Conventionally, the treatment of carotid artery disease customizes stents to the vessel diameter. The design of the CGuard stent and its nitinol shape memory allow for a wide operational range and minimal residual radial force. This pilot study assesses the feasibility and clinical outcomes of the 10-mm CGuard stent in a one-size-fits-all sizes protocol.

Materials and methods: The study is a multicenter, prospective cohort study involving 226 consecutive patients with symptomatic or asymptomatic carotid artery stenosis, with an indication for revascularization. All patients received the 10-mm CGuard stent, irrespective of the carotid artery reference diameter, and were grouped into three categories based on the reference vessel diameter. Endpoints included procedural success and incidence of major adverse cardiovascular events (MACE) at 30 days and 1 year.

Results: The study achieved 100% technical success, with an average residual stenosis of 8.41%. Clinical success was 98.7%. During in-hospital observation, one patient experienced a major ipsilateral stroke (0.4%), and two patients had transient ischemic attacks (TIAs) (0.8%). At the 30-day follow-up, there were one death and one case of re-occlusion which was asymptomatic. No differences between the three groups were found regarding technical or procedural success, residual stenosis, complications, TIAs, MACEs, or patency rates. No events occurred between the 30-day and 1-year follow-up, maintaining the MACE rate at 1.5%. ICA and ECA patency rates at 1 year were 99% and 99.4%, respectively, indicating mid-term treatment effectiveness.

Conclusion: This pilot study demonstrates that the one-size-fits-all approach using a 10-mm CGuard stent to treat carotid artery stenosis provides minimal residual radial force with optimal stent apposition. The one-size-fits-all approach with CGuard stent is feasible, safe, and effective. Further studies for confirmation are guaranteed.