CardioVascular and Interventional Radiology最新文献

Purpose: To evaluate the safety and efficacy of ticagrelor-based dual antiplatelet therapy (DUAP) in patients undergoing stent-assisted endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs) in a large single-center cohort.

Methods: We retrospectively analyzed 153 patients who underwent elective stent-assisted EVT for UIAs and were exclusively managed with aspirin and ticagrelor from January 2021 to December 2024. Clinical outcomes included thromboembolic events (cTE), hemorrhagic events (HE), disability, and mortality. Follow-up involved cone-beam CT for early hemorrhagic complications, scheduled MRI/MR-A, and digital subtraction angiography (DSA) at six months. Outcomes were compared across treatment types: stent-assisted coil embolization (SACE, laser-cut or braided), Y-stenting, flow diversion (FD), and stent monotherapy.

Results: Among 153 patients (mean age 54.8 ± 13.2 years; 75.2% female), thromboembolic events occurred in 4 (2.6%) and hemorrhagic events in 6 (3.9%) cases during a mean follow-up of 22.5 ± 15.9 months. Permanent disability occurred in 3 patients (2.0%) and mortality in 2 (1.3%). Event rates did not differ significantly among treatment subgroups (p > 0.05).

Conclusion: Ticagrelor-based DUAP was associated with low thromboembolic and hemorrhagic complication rates in patients undergoing stent-assisted endovascular treatment of unruptured intracranial aneurysms, supporting its safety and efficacy in this setting.

Purpose: This clinical study presents a new technique in tract embolisation to prevent pneumothorax formation in lung ablation. The tandem needle technique pleural blood patch (TNT PBP) involves insertion of a needle adjacent to the ablation applicator for injection at the pleura during applicator withdrawal.

Material and methods: Retrospective case series including TNT PBP embolisation procedures performed concomitantly with lung ablations within a one-year period at a tertiary institution. Patient factors, technical aspects, clinical and radiological outcomes are reviewed. Clinical success is defined as successful administration of blood patch and avoidance of need for chest drain. Descriptive and inferential statistical tests are performed.

Results: 12 patients underwent ablation/TNT PBP procedures for 14 lung tumours. All patients had multiple comorbidities and were considered high risk of pneumothorax formation. TNT PBP was successfully administered to all patients. 1/12 patients required a post-procedural chest drain. All but 1 patient experienced expected post-operative clinical pathway and were discharged the next day. On latest follow-up (233.7 ± 67.8 days), no procedure-related complications were demonstrated.

Conclusion: TNT PBP showed promising safety and efficacy profile. Further evaluations are required, and this is currently being investigated in a randomised controlled trial (Oxford Pleural Embolisation Trial, OxPET, NCT06651658).

Purpose: To report up to 6-month outcomes of genicular artery embolization (GAE) using polyethylene glycol microspheres vs ethiodized oil emulsion in patients with medically refractory symptomatic knee osteoarthritis (KOA).

Material and methods: In this single-center retrospective study, sixty-eight patients (65 y.o, M/F (11/57)) underwent GAE from 9/2021 to 3/2025 using a permanent agent: 200-micron microspheres (HydroPearl®, n = 42), or a temporary agent: emulsion of ethiodized oil (LipioJoint, n = 46). Outcomes were assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total and Pain sub-score at baseline, 1, 3, and 6 months post-GAE. Adverse events (AEs) were reported by the CIRSE AE classification system. A descriptive statistical and multivariable analysis was performed.

Results: Eighty-eight knees treated with KOA severity: Kellgren-Lawrence (KL) 2: 10 vs 23%, KL 3: 57 vs 33%, KL4: 33 vs 44%, respectively (permanent vs temporary, P = 0.051). Pain sub-scale score decreased by 27 vs 44%, 25 vs 37%, and 23 vs 36% at 1, 3, and 6 months, respectively. There was higher percent WOMAC pain reduction in ethiodized oil emulsion at 1 but not at 3 and 6 months (P = 0.020-0.119). Adverse events included: skin changes without ulceration (n = 14), knee swelling requiring prednisone (n = 5), and access site hematoma (n = 2). A lower AE rate was observed for total AEs and skin changes with ethiodized oil emulsion (P = 0.018).

Conclusion: GAE shows positive short-term outcomes up to 6 months post-treatment for KOA with temporary and permanent embolic agents. Ethiodized oil may offer a better short-term efficacy and lower risk of skin discoloration compared to polyethylene glycol microspheres.

Purpose: To assess the feasibility and safety of percutaneous gallbladder cryoablation combined with gallstone extraction for calculous cholecystitis and cryoablation alone for acalculous cholecystitis.

Materials and methods: A dual-tertiary center retrospective case series included 12 patients (median age, 66.0 years; three females and nine males) with benign gallbladder disease who underwent percutaneous gallbladder cryoablation between April 2023 and May 2025. Ten patients underwent percutaneous cholangioscopy-guided gallstone extraction prior to cryoablation, while two patients without gallstones received cryoablation alone. Descriptive statistics were collected for patient demographics, clinical presentation, procedural details, technical success, adverse events, symptom recurrence and resolution rates, and imaging findings.

Results: The median follow-up was 540.5 days. Technical success was achieved in 91.7% (11/12), with one procedure aborted due to the inability to safely hydrodissect the colon from the gallbladder. All 11 patients who underwent successful cryoablation reported complete symptom resolution at 1-month and during subsequent follow-up. Follow-up imaging demonstrated progressive involution of the devitalized, nonenhancing gallbladder. No immediate procedure-related complications occurred, and all patients were discharged within 24 h. One patient developed a minor procedure-related adverse event on post-procedure day 4 (self-limited scrotal edema), and another experienced transient biliary obstruction 3 months later, presumably related to the choledochocele.

Conclusions: Gallbladder cryoablation, performed alone for acalculous cholecystitis or in combination with gallstone extraction for calculous cholecystitis, is technically feasible, safe, and associated with effective symptom relief.

Purpose: To evaluate the association between hemodynamic depression (HD) during CAS and major adverse cardiovascular events (MACE).

Methods: We systematically searched four major databases for studies reporting the HD and MACE during CAS. The risk of bias in the included studies was assessed using a modified version of Newcastle-Ottawa scale. The heterogeneity between the studies was evaluated based on the I² statistic and Dixon's Q-test. We assessed heterogeneity using the I² statistic. A fixed-effect model was used if I² < 50%; otherwise, a random-effects model was applied. Results were reported as ORs with 95% CIs. Funnel plots and Egger's test were used to evaluate the publication bias.

Results: Fourteen studies comprising 4418 patients were included in the meta-analysis. Evidence of low certainty indicated that the occurrence of HD was significantly associated with an increased risk of stroke (OR 2.12, 95% CI 1.4-3.22, I² = 0), transient ischemic attack (TIA) (OR 2.72, 95% CI 1.51-4.88, I² = 41.2), and all-cause mortality (OR 2.81, 95% CI 1.22-6.44, I² = 0). However, very low-certainty evidence suggested no significant association between HD and myocardial infarction (MI) (OR 1.49, 95% CI 0.61-3.61, I² = 0).

Conclusions: HD during CAS is significantly associated with a risk of TIA, stroke, and all-cause mortality, but not with the risk of MI.

Purpose: This review explores the clinical utility of spectral CT in interventional radiology (IR), including applications in pre-procedural planning, intra-procedural guidance, and post-procedural evaluation.

Methods: A narrative review was conducted exploring the use of spectral CT in IR, examining its applications across the clinical workflow.

Results: Spectral CT demonstrates strong potential to enhance diagnostic precision and procedural safety in IR practice.

Conclusion: Spectral computed tomography (CT) is an emerging imaging modality that offers numerous benefits including enhanced tissue characterization, improved lesion detection, and artifact reduction compared to conventional CT. Future implications of this modality include integration of artificial intelligence, photon-counting technology, and integration into clinical workflows.