CardioVascular and Interventional Radiology最新文献

Purpose: To evaluate the safety and local efficacy of irreversible electroporation (IRE) for soft tissue lesions near or involving gastrointestinal structures.

Material and methods: This single-center retrospective study analyzed patients treated with percutaneous IRE for lesions near or involving gastrointestinal structures from June 2018 to March 2024. Safety was assessed by complications graded according to CTCAE criteria. Efficacy, a secondary outcome, was evaluated based on tumor response and local progression-free survival (LPFS) using mRECIST and PERCIST criteria. Additional secondary outcomes included length of hospital stay.

Results: Twenty-five patients underwent IRE for 30 lesions near the stomach, small bowel, colon, or rectum. Primary cancers included pancreatic (n = 1), uterine (n = 1), urothelial (n = 2), prostate (n = 2), small intestine (n = 3), renal cell (n = 4) and colorectal (n = 12). Median age was 65 years, mean lesion size 2.4 cm, and technical success 100%. Complications occurred in 34.8% (all grade 1), with no gastrointestinal perforations. Median hospital stay was 1 night. Median follow-up was 25.3 months; LPFS was 24.4 months, with 1- and 2 year rates of 62.0% and 54.3%. In the colorectal cancer subgroup, LPFS was 23.8 months, with 1- and 2 year rates of 58.7% and 47.0%, and median OS 56.1 months (1 year: 100%, 2 year: 87.5%).

Conclusion: IRE is found to be safe and an effective local treatment for soft tissue metastases near the gastrointestinal tract, offering promising control with minimal complications in challenging anatomical locations. Level of Evidence 4 (retrospective study without a control group).

Purpose: To evaluate the short-term follow-up experience with treating juxtarenal aortic aneurysm or type 1a endoleak after previous endovascular aneurysm repair (EVAR) by using the novel semi-branched endograft (sBEVAR) (Artivion, Hechingen, Germany).

Methods: All consecutive patients undergoing elective aortic aneurysm repair with the sBEVAR graft from Artivion were retrospectively reviewed from the electronic patient files. Indications for sBEVAR were a juxtarenal or suprarenal aortic aneurysm or type 1a endoleak after previous EVAR, with suitable anatomy for endovascular repair. Primary outcome was technical success, defined as successfully placing the sBEVAR and placing bridging stents in the planned target vessels without type I or III endoleak at the end of the procedure. Any complication during or after the procedure was registered, as well as target vessel patency and any reintervention during the current follow-up.

Results: A total of 21 patients were included in the analysis. Technical success was achieved in 20 patients (95.2%), with acute conversion to open repair in 1 patient due to rupture of the left common iliac artery. A further 4 patients had complications during the procedure. Mean follow-up was 10 ± 5,7 months. Primary target vessel patency was 98.7% during follow-up. Four reintervention procedures were necessary during the follow-up period, with a reintervention-free survival rate of 81.0%. Overall survival was 90.5%.

Conclusion: The findings in this retrospective study confirm that sBEVAR using the Artivion design platform is a safe and feasible technique for treating complex aortic aneurysms. The technique achieves a high technical success rate and demonstrates reintervention rates comparable to inner-branched EVAR and fenestrated EVAR.

Design and purpose: To assess feasibility and technical outcome of endobiliary cryobiopsy compared to standard technique of endobiliary forceps biopsy in randomized study.

Material and methods: This prospective study included 22 patients with indeterminate biliary stenosis. All patients underwent percutaneous endoluminal forceps biopsy and endoluminal cryobiopsy under the fluoroscopy guidance. The order of sample collection was randomized. The technical feasibility of cryobiopsy and the rate of serious complications were analyzed. Sensitivity in detecting malignancy, sample weight, total sample area, sample area without artifacts, and sample quality (five-point Likert scale) assessed by two certified pathologists were compared between both methods.

Results: No CTCAE (Common Terminology Criteria for Adverse Events) v.5 grade 3-4 complications were reported during or after the procedure, and cryobiopsy was technically feasible in all patients. Three of 22 patients were excluded from the analysis. A total of 232 samples were collected (112 forceps biopsy, 120 cryobiopsy). Cryobiopsy and forceps biopsy respectively detected carcinoma in 15/19 patients and 11/19 patients in total yielding positive diagnostic histology for malignancy in 79% and 58% (p = 0.11). Among the 17 patients ultimately diagnosed with malignancy, sensitivity for cryobiopsy and forceps biopsy was 88% and 65%, respectively and overall accuracy was 89% (17/19) or cryobiopsy and 68% (13/19) for forceps biopsy. Cryobiopsy provided significantly larger total and artifact-free sample areas (median 2.66 vs 0.84 mm² and 1.77 vs 0.18 mm², respectively; p < 0.001), fewer non-evaluable samples (8% vs 40%; p < 0,001), and a significantly greater median weight (7.6 vs 3.6 mg; p < 0.001). Cryobiopsy samples demonstrated markedly superior quality assessments (median Likert scale value 4 vs 2, p < 0.001; Likert > 2 in 83% vs 38%, p < 0.001).

Conclusion: Cryobiopsy in the biliary tract appears to be a safe and feasible technique, allowing more representative histological samples to be obtained compared with forceps biopsy.

Level of evidence: Level 1, Randomized trials.

Purpose: To evaluate the preclinical efficacy and safety of transarterial chemoembolization (TACE) using doxorubicin-loaded biocompatible cellulose nanoparticles in a rabbit VX2 liver tumor model.

Materials and methods: Following institutional animal care committee approval, 23 rabbits with VX2 liver tumors were randomized into three groups: Group A (n = 9) received doxorubicin-loaded cellulose nanoparticles with ethiodized oil; Group B (n = 9) received doxorubicin with ethiodized oil; and Group C (n = 5) served as untreated controls. Tumor size was monitored via ultrasound for 4 weeks, and serum liver enzymes (aspartate transaminase and alanine transaminase) were measured on days 1, 3, and 7 to assess hepatotoxicity. An additional 10 healthy rabbits were randomized into two groups: Group D (n = 5) received doxorubicin-loaded cellulose nanoparticles with ethiodized oil, and Group E (n = 5) received doxorubicin with ethiodized oil, to measure serum doxorubicin concentrations up to 30 min post-treatment.

Results: Group A demonstrated significantly slower overall tumor growth compared to Group C (p = 0.005) and slower growth between days 24 and 27 compared to Group B (p = 0.037). Pharmacokinetic analysis showed significantly lower serum doxorubicin levels in Group D than Group E at 2 and 5 min post-delivery (p < 0.05). Hepatotoxicity peaked at 24 h, with significantly lower alanine transaminase levels in Group A compared to Group B (p = 0.025), normalizing by day 7.

Conclusion: TACE using doxorubicin-loaded cellulose nanoparticles demonstrated promising preclinical efficacy and safety compared to conventional TACE.

Level of evidence: No level of evidence, Animal Study.

Purpose: Calcified occlusive lesions are independently associated with higher failure rates of endovascular treatment. Intravascular lithotripsy (IVL) is emerging as a promising innovation in calcified vessel preparation. The aim of this study was to assess the safety and efficacy of IVL in the treatment of calcified common femoral artery (CFA) lesions, and to evaluate the role of adjunctive stenting in maintaining mid-term patency.

Methods: This is a retrospective, single-center observational study. Demographic, procedural (before and after IVL), and follow-up data were analyzed. IVL was used for moderate or severe calcifications (plaque > 180° of circumference) according to the PARC (Peripheral Academic Research Consortium) classification. Results are expressed as means with standard deviations.

Results: From September 2021 to May 2024, 37 calcified lesions in 30 patients were treated with IVL. Most presented with ischemic rest pain (78.4%, N = 29). Severe calcifications were present in 75.7% (N = 28) of cases. After IVL, vessel preparation was satisfactory (residual stenosis ≤ 30% without flow-limiting dissection) in 81% (N = 30) of lesions, with a median luminal gain of 50% [IQR: 40-66%]. No intra or postoperative complications were observed. Among the 37 lesions, 45.9% (N = 17) required stenting, either planned or as bail-out for significant recoil. At 6 months, primary patency was significantly higher in the stenting group versus the non-stenting group (100%vs.75%, p = 0.049). Kaplan-Meier analysis confirmed the benefit of stenting in maintaining mid-term vessel patency (log-rank p = 0.02).

Conclusion: Our study highlights that an aggressive stenting strategy following IVL in the CFA should be favored. These findings question the commonly held preference for a "leave nothing behind" strategy associated with IVL.