CardioVascular and Interventional Radiology最新文献

Purpose: Evaluate safety and efficacy of lung cancer cryoablation in patients with stereotactic body radiation therapy (SBRT) recurrence.

Materials and methods: Between 9/2018 and 11/2023, all patients with non-small cell lung cancer (NSCLC) treated with lung cryoablation after SBRT recurrence were retrospectively identified. Histories of smoking, COPD, post-procedural pneumothorax, adverse events requiring immediate post-procedural hospitalization, and initiation/worsening of home oxygen requirements 3-6 months later were obtained. Technical success was defined as ability to envelope the targeted tumor with an ice-ball without premature cessation of the cryoablation protocol. Outcome measures included local control, local progression-free survival, and overall survival at 6 months, 1 year, 2 years, and 3 years.

Results: 29 patients with NSCLC recurrence after SBRT underwent percutaneous cryoablation with 35 treatment sessions. Mean lesion size and standard deviation was 2.8 ± 1.5 cm (Range, 1.0-7.4 cm). Pneumothorax and hospitalization rates were 44.4% (16/36) and 36.1% (14/36). The mean number of ablation probes was 2.5 ± 1.5 (Range, 1-6). Twenty-six patients had COPD (92.9%), of which 3.8% (1/26) had new or worsened home oxygen requirements. All (36/36) cryoablations achieved technical success. Local control, local progression-free survival, and overall survival were 100%/92.9%/92.9% at 6 months, 76.2%/70.8%/92.9% at 1 year, 64.9%/60.3%/62.3% at 2 years, and 31.5%/22.6%/35.4% at 3 years.

Conclusion: Percutaneous cryoablation of non-small cell lung cancer may be a safe and effective treatment alternative for recurrence after SBRT without worsening pulmonary function.

Purpose: To compare the radiological and histological effects of three different cyanoacrylate glues used for in vivo renal artery embolization in rabbits.

Materials and methods: N-butyl cyanoacrylate (NBCA), NBCA-methacryloxysulfolane (NBCA-MS), and α-hexyl-cyanoacrylate (AHCA) were each used to embolize five renal arteries under free-flow conditions with a 1:3 glue/ethiodized oil ratio. The rabbits were euthanized 30 min after embolization. Micro-computed tomography (CT) was used to assess glue cast distribution (extent of penetration into the vascular tree), fragmentation (presence of discontinuities within the cast), and heterogeneity (variability in cast density). Histological slides were analyzed for lumen dilatation, intimal arteritis, necrosis, and peri-arterial edema. Statistical analyses were performed using the Kruskal-Wallis test.

Results: Glue penetration into interlobar and corticomedullary arteries was observed consistently in all three groups. Fragmentation scores showed no significant differences between glue types, but AHCA demonstrated significantly lower heterogeneity in proximal arteries compared to NBCA-MS (P = 0.019). Severe lumen dilatation and intimal necrosis were observed in all samples, whereas intimal arteritis was significantly less severe with AHCA compared to NBCA-MS (P < 0.001). No significant differences in peri-arterial edema were found between groups.

Conclusion: Micro-CT features were similar with all three glues. AHCA produced greater cast uniformity and less intimal arteritis, suggesting a role in endovascular embolization.

Purpose: To evaluate the relationship between radioembolization tumor dose and imaging response for hepatocellular carcinoma (HCC) treated with radioembolization.

Materials and methods: Retrospective single-institution evaluation of treatment-naïve patients with HCC who underwent TARE between November 2017 and September 2020. Dose-volume histograms (DVHs) were calculated from post 90Y single-photon emission computed tomography. Cross-sectional imaging was obtained at 3 months after radioembolization and evaluated by three blinded abdominal radiologists.

Results: Forty-one patients underwent radioembolization who met the inclusion criteria. Median age was 67 years (range 41-84); 11 were female. At 3 months, 23/41 (56%) had complete response (CR), 9/41 (22%) had partial response (PR), and 8/41 (20%) had stable disease (SD) by mRECIST criteria. DVH analysis demonstrated that increased dose to different tumor volumes was predictive of a complete imaging response at 3 months (p < 0.05 for all). Receiver operating characteristic (ROC) analysis demonstrated a dose threshold of 687 Gy to 95% of the tumor volume resulted in the highest area under curve (AUC) at 0.86 (CI 0.73-0.95) and a positive predictive value (PPV) of 82% to predict complete response by mRECIST criteria.

Conclusion: Voxel-based dosimetry demonstrates that several dose thresholds are predictive of a complete imaging response by mRECIST criteria. A threshold dose of 687 Gy to at least 95% of the tumor volume led to the highest accuracy in predicting complete response by mRECIST criteria.

Level of evidence: Level 3, Cohort Study.

Purpose: Corticosteroid injections are commonly used to treat symptomatic knee osteoarthritis; however, pain relief is usually transient. Genicular artery embolization (GAE) has shown promise as an effective minimally invasive intervention to alleviate symptomatic knee osteoarthritis. The MOTION study is being conducted to compare outcomes following GAE versus corticosteroid injection.

Materials and methods: This is an international, multicenter, randomized controlled investigational device exemption (IDE) study enrolling adults (≥ 21 years old) with symptomatic knee osteoarthritis (Kellgren-Lawrence grades 1-4) across ≥ 45 centers worldwide. Patients will be randomized 1:1 to receive GAE with Embosphere® Microspheres (Merit Medical Systems, Inc.) or corticosteroid injections. The primary efficacy measure is clinical success at 6 months, defined as ≥ 50% improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Subscale. The primary safety measure is the proportion of patients free from treatment-related safety event(s) through 6-month post-index procedure (GAE or corticosteroid injection). Following the 6-month visit, patients in either cohort who do not achieve clinical success may crossover to the other study arm. Additional study measures will assess safety and efficacy outcomes throughout the 24-month follow-up period. The target sample size is 264 (132 per arm) and is based on the number of patients needed to confirm superior efficacy of GAE versus corticosteroid injections and non-inferiority with respect to safety. The overall study power is > 80%.

Discussion: Findings from the MOTION study are expected to provide information on the magnitude of the therapeutic benefits associated with GAE versus standard of care over 24 months.

Trial registration: NCT05818150.

Direct intrahepatic portosystemic shunt (DIPS) with access to the portal vein from the IVC remains a viable option to ameliorate features of portal hypertension in patients of BCS with chronically thrombosed hepatic veins. We present a case of BCS with concurrent extrahepatic portal vein obstruction (EHPVO), in which portal vein recanalization (PVR) was achieved utilizing recanalized paraumbilical venous access. Subsequently PVR-DIPS was performed to ameliorate features of portal hypertension.